Enlarged Male Breasts

 In

Enlargement or swelling of breast in boys or men is called Gynecomastia. Not a serious problem, caused mostly by an imbalance of the hormones oestrogen and testosterone. Either one or both breasts can be affected, with or without pain. Oestrogen is a female hormone and testosterone is a male hormone. Both hormones are present in either sex, but decreased testosterone compared to oestrogen can lead to gynecomastia.  Newborn babies, boys going through puberty and older men may develop temporary gynecomastia under the influence of normal changes in hormone levels. In most cases it wanes away within six months to two years without a treatment. But a psychological discomfort, larger swelling, pain, nipple discharge or failure to wane should prompt one to visit a doctor.

In addition to being normal change due to hormonal imbalance at growth stages, it can be caused because of

  • Medications like steroids, androgens, antiviral, antidepressants, anti-cancer, etc.
  • Alcohol and narcotics like Amphetamines, Marijuana, Heroin, Methadone
    • Hyperthyroidism
    • Kidney failure
    • Liver failure and cirrhosis
  • Malnutrition and starvation reduces testosterone secretion
  • Hypogonadism: Klinefelter’s syndrome or pituitary insufficiency can interfere with normal testosterone production
  • Aging: Hormonal changes with normal aging especially in men who are overweight
  • Tumors of  testes, adrenal glands or pituitary gland

Enlarged Breast in Male: What can it be?

Enlarged breast in an adolescent boy or man can be cause of emotional stress and physical embarrassment. Enlarged breast in male can mean

  • Newborn babies, boys going through puberty and older men due to normal hormonal changes. It typically wanes away in six months to two years.
  • Gynecomastia occurring because of any of the above reasons. It mostly gets resolved if underlying cause is treatment.
  • Mastitis, an infection of breast
  • Rarely a breast cancer
  • Benign condition like lipoma, sebaceous cyst, dermoid cyst
  • Hematoma, which means collection of blood due to trauma
  • Enlargement of the pectoralis muscles can sometimes be confused with gynecomastia
  • Fatty chest can also mimic gynecomastia

Diagnosis

Doctor would like to know about medical, family and drug history before arriving to a diagnosis. Your doctor will also do a physical examination to evaluate breast tissue, abdomen and genitals. Gynecomastia usually presents with bilateral involvement of the breast tissue but may occur unilaterally as well.

Initial tests to determine the cause of gynecomastia include:

  • Blood test for liver like AST and ALT
  • Blood test for kidney like Creatinine
  • Blood test for thyroid like T3, T4 and TSH
  • Markers of testicular, adrenal, or other tumors such as urinary 17-ketosteroid, serum ß HCG, or serum dehydroepiandrosterone.
  • Blood levels of testosterone, oestrogen, luteinizing hormone and follicle stimulating hormone to rule our hypogonadism
  • USG of testes and abdomen
  • CT scan
  • MRI scan
  • Biopsy of breast

Treatment

In adolescents with no apparent cause of gynecomastia, periodic re-evaluation after every three to six months is recommended. Gynecomastia due to an underlying condition, such as hypogonadism, malnutrition or cirrhosis needs treatment. Advised stoppage or substitution of medications that can cause gynecomastia reverts it. Persistent and bothersome breast enlargement despite medical treatment may need a surgery. Either liposuction for removal breast fat or mastectomy for removal of the breast gland tissue can be done. A minimally invasive surgery by the hands to a skilled surgeon results in minimal scarring with less recovery time.

75% of gynecomastia regresses within six months to two years without treatment. Intervention may be needed if it is associated with larger swelling, pain, tenderness, nipple discharge or embarrassment.

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