Only medication can reduce gynecomastia
Gynecomastia (male breast)
What is gynecomastia?
Gynecomastia describes the enlargement of the man's mammary gland. It is to be distinguished from lipomastia, in which only fats are stored in the man's chest. In gynecomastia, on the other hand, mammary gland tissue forms in men, and this enlargement can occur on one or both sides.
The mammary gland enlargement is in most cases benign, but it can also - especially in the case of a one-sided enlargement of the breast - a Breast cancer in men be. An ultrasound scan combined with a Mammography should therefore also be carried out in the event of minor doubts.
Frequency and classification in an enlarged male breast
The pathogenesis of gynecomastia is incomprehensible in half of all those affected. While over 90 percent of all newborns have physiological gynecomastia, this probability drops to around 50 to 70 percent at puberty, although pubertal gynecomastia does not have to have a disease value. About half of all men suffer from a "man's bosom" at some point in their life.
In order to be able to assign the stages of gynecomastia, they are divided into three grades according to Deutinger:
- Grade I: A small, inconspicuous man's breast manifests itself.
- Grade II: The man's breast resembles a young girl's breast.
- Grade III: The gynecomastia is pronounced and has an underbust fold.
Causes: why can gynecomastia develop?
Gynecomastia can arise in a physiological and non-physiological way. The physiological male breast defines a non-pathological change.
Physiological: Gynecomastia is normal if it occurs in infancy, puberty, or old age. Gynecomastia therefore takes place purely on a hormonal level; it can also be observed, for example, in people who are very overweight. However, only fatty tissue is stored here, so that it is not a real gynecomastia and one speaks of a pseudogynecomastia or lipomastia.
Non-physiological: This is where the enlargement of the man’s breast occurs due to a pathological change caused by medication or a disturbance in the man’s hormonal balance.
Specific drugs are an important factor in the development of gynecomastia:
- Finasteride: A prostate drug that is also used as a hair restorer
- Anabolic steroids: Means in bodybuilding to build muscle (bodybuilders call it “Gyno” for short)
- Spironolactone: A diuretic for the kidneys
- Gastric acid tablets: cimetidine, omeprazole, pantoprazole, ranitidine
- Hormonal drugs: estrogens and antiandrogens are increasingly used in sex reassignment
- Heart preparations: rather rare, digitalis, B-blockers, calcium antagonists
- Alcohol and drug abuse can also trigger pathological gynecomastia.
Hormonal imbalances as the cause of an enlarged man's breast
If there is an excess of the female sex hormone estrogen or a deficiency in the male sex hormone testosterone, gynecomastia can develop. The increase in estrogen takes place in tumors of the adrenal cortex or testicles.
In addition, cirrhosis of the liver can also trigger the symptom of gynecomastia. A deficiency in androgenic hormones is due to non-applied testicles, castration, an overactive thyroid, or to a specific disease like that Prolactinoma or Klinefelter syndrome, in which patients have one too many X chromosomes.
How is gynecomastia diagnosed?
In any case, the diagnosis includes a laboratory test of the hormones as well as the liver and thyroid values by means of a simple blood sample. Especially in older patients with a one-sided Breast augmentation A highly aggressive, malignant breast cancer in men should be ruled out by an appropriate mammography and ultrasound examination.
The diagnosis is better, the more the attending physician knows about the patient's medical history and the more precise his physical examinations are, because this is the only way to develop an optimal treatment concept for each patient.
Pain plays a rather subordinate role when the man's breast is enlarged. It is more the psychological dimension that troubles those affected: in terms of appearance and also in terms of their body awareness as a man.
Typically, gynecomastia also enlarges the nipples and areola. The glandular tissue can be easily distinguished from the fatty tissue: As the tissue grows, it pushes the nipple outward so that it appears larger.
If an extreme form of gynecomastia manifests, the so-called underbust fold can also develop, as in a woman. Particular attention should be paid to breast cancer in men: The changes can be like those in a woman, but usually only occur on one side with the following symptoms:
- There is bleeding in the area of the wart, with very coarse palpable nodules
- The skin can pull in or pucker
- The skin is inflamed
- In advanced breast cancer, the skin bulges like an orange peel
- Tissue defects and swelling of the armpit can also occur at an advanced stage.
The treatment options can be conservative without surgery or include surgical procedures.
Gynecomastia treatment without surgery
The conservative method tries to alleviate the symptoms mentioned above and to eliminate possible disturbances in the hormonal balance. Here, the interaction of different specialists is required: endocrinologists, cardiologists, internists, general practitioners and urologists usually work together. Conservative therapy cannot reduce the size of an enlarged man's breast, but it can prevent or slow down the progressive enlargement. So often conservative and operative methods are combined.
Gynecomastia surgery: breast reduction in men
The gynecomastia surgery depends on the type of breast augmentation.
Operation of pseudogynecomastia
If there is a fatty man's breast, is in most cases liposuction is indicated . You can often do without an incision of the areola. Instead, you make a small incision in the edge area of the pectoral muscle, infiltrate a small fluid that makes the fatty tissue larger and then suction it off.
In some cases the man's breast is so pronounced that liposuction alone would not bring good results, so that one is forced to do liposuction as well classic breast reduction to undertake.
Real gynecomastia surgery
A glandular breast enlargement cannot be compensated for with liposuction alone, as the glandular tissue is too coarse and firm. One uses liposuction and removal of the male mammary gland, the so-called Andromastectomy . Here you make an incision in the area of the nipple, through which you can remove the excess glandular tissue.
Since gynecomastia often leads to an enlargement of the nipple, it can also be reduced during the operation. At the end of each of these operations, drains are inserted to remove the tissue fluid.
In the case of an extreme form of gynecomastia (grade III according to Deutinger), a breast reduction may very well be indicated, which is also carried out in women: A T-cut, I-cut or a special incision in the areola provides access and removes the glandular tissue. The breast can then be tightened and sewn up again.
What should be considered after the gynecomastia operation?
If a breast reduction was only achieved through liposuction, outpatient treatment is also possible. However, if an andromastectomy has been performed, hospitalization becomes inevitable. If the disease is severe to moderate, the patient is operated on under general anesthesia.
As with any operation, general risks and complications such as infections, hematomas, secondary bleeding or wound healing disorders can occur, although these are rare. A sports break should be taken up to six weeks after the operation. In addition, a compression vest is absolutely necessary, especially in the initial phase after the operation, to prevent or minimize swelling, water and bruising.
Which doctors and clinics are gynecomastia specialists?
Those affected with an enlarged male breast should first clarify the cause. The first point of contact is usually the family doctor. If a malignant breast cancer or hormone disorder is suspected, the doctor can issue the necessary referral to a specialist in gynecology, urology or endocrinology. After this has been done and the person concerned wants a gynecomastia operation, he should contact a specialist in plastic and aesthetic surgery. They specialize in male breast reductions.
We help you to find an expert for your illness. All listed doctors and clinics have been checked by us for their outstanding specialization in the area of gynecomastia surgery and await your inquiry or your treatment request.
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