Geneko Masti

Gynecomastia is a benign enlargement of male breast tissue and is the most common breast disease in men. At least 30% of men will be affected during their lifetime. Because breast cancer causes anxiety, psychosocial distress, and fear, early diagnosis is important, and patients usually seek medical care. Gynecomastia is due to increased estrogen production, decreased androgen production, or both, causing an imbalance between estrogen and androgen function or an increased estrogen-to-androgen ratio.
Evaluation of gynecomastia should include a detailed medical history, clinical examination, blood tests, imaging, and tissue sampling. Individual treatment requirements can range from simple reassurance to drug therapy or even surgery, and the primary goal of any intervention is to relieve symptoms and eliminate other causative factors.

The truths we should know about gynecomastia

The appearance of enlarged breast tissue in men can be due to the actual enlargement of the breast tissue or due to the deposition of fat in the chest area. Actual breast tissue enlargement is due to hormonal fluctuations or imbalances. Breast enlargement in men due to this condition is called gynecomastia. However, fat tissue may increase in the chest area, especially in obese or overweight men. This condition, which is not the same as actual enlargement of male breast tissue, creates the appearance of enlarged breasts and is known as pseudogynecomastia.

Doctors can usually tell if breast enlargement in men is due to true gynecomastia with a physical exam, but sometimes another test is needed. True gynecomastia (enlargement of breast tissue) is not uncommon in men and can occur in normal, healthy boys during puberty or in men as they age. Medical conditions that interfere with the body’s hormonal balance can cause breast enlargement in men.
Obesity and weight gain are the biggest risk factors for the development of fatty tissue in the breast area.

What is the cause of men's breast enlargement and their need for gynecomastia surgery?

Men may be at risk of gynecomastia during puberty, which is part of the normal growth process. Normal baby boys may also have gynecomastia.
Some of the following reasons can also be the cause of male breast enlargement:

Aging may be associated with a decrease in testosterone production, which can cause this problem.
Complications related to diseases and conditions (such as cirrhosis of the liver).
Taking certain medications may increase the risk of developing this problem.

Normal hormonal changes in men

The hormones testosterone and estrogen control sexual characteristics in men and women.
Testosterone controls male characteristics such as muscle mass and body hair. Estrogen controls female characteristics, including breast development. Most people think of estrogen as just a female hormone, but men also produce it—though usually in small amounts. Men’s estrogen levels that are too high or out of balance with testosterone levels can cause gynecomastia.

Gynecomastia in Babies More than half of baby boys are born with enlarged breasts due to the effects of their mother’s estrogen. Generally, the swollen breast tissue will disappear within two to three weeks after birth.

Gynecomastia during puberty Gynecomastia caused by hormonal changes during puberty is relatively common. In most cases, the swollen breast tissue will disappear within six months to two years without treatment. Gynecomastia in adults, researchers have estimated that the prevalence of men aged 50 to 80 is between 24 and 65%. However, most men with this disease have no symptoms.

The most important symptoms of gynecomastia

The biggest symptom of gynecomastia is breast enlargement in men. As mentioned earlier, gynecomastia in men is an enlargement of glandular tissue rather than fatty tissue.
It is usually symmetrical in nipple position and may be rubbery or firm.
Gynecomastia usually occurs on both sides, but in some cases it can be unilateral. Enlargement may be greater on one side even if both sides are involved. Tenderness may be present, although there is usually no severe pain. The most important distinction between gynecomastia and male breast cancer, which accounts for about 1% of all breast cancers, is that the cancer is usually limited to one side, is not necessarily centered around the nipple, feels hard or firm, and can be dimpled. Skin, nipple retraction, nipple discharge, and enlarged axillary (armpit) lymph nodes are associated.

How is gynecomastia surgery performed?

This surgery involves a combination of liposuction and direct removal of the glands through a small incision at the nipple border. Beware of surgeons who claim they can treat it with liposuction alone. Liposuction only removes the fat component, and after the swelling subsides, you are left with a smaller version of what was there before.
Breast reduction surgery for men is performed under general anesthesia and takes about 2 hours. Fat injection is first performed to remove the fat component that condenses into the gland tissue. Then a small incision is made on the lower border of the nipple.

Then the glandular tissue is carefully removed. Many inexperienced surgeons cannot do this by making an opening in the middle of the chest. A small amount of glandular tissue is left just behind the nipple to prevent collapse and indentation.

Suction drainage is often used in the first few days after surgery to prevent fluid from collecting in the previous pocket of tissue.

To ensure the result of the operation, choose the best doctor

As we said, these days, breast reduction surgery for men as one of the treatment methods for gynecomastia helps many men to have a body like before. At Dr. Reza Vaqardoost’s clinic, we use various methods for gynecomastia surgery so that you can recover and return to your ideal condition in the shortest possible time.

If you are thinking of gynecomastia surgery but you don’t know who is the best doctor for gynecomastia surgery in Tehran? We assure you that the professional group of treatment staff of this clinic is one of the best.

What diseases and conditions cause gynecomastia?

Some medical conditions may also lead to gynecomastia:
Malnutrition and (recovery from) malnutrition have been shown to create a hormonal milieu that may lead to gynecomastia. Similarly, cirrhosis of the liver alters the normal metabolism of hormones and may lead to gynecomastia.
Disorders of the male sex organs (testicles) can lead to decreased testosterone production and relatively high levels of estrogen, leading to gynecomastia in men. These disorders may be genetic, such as Klinefelter syndrome, or caused by trauma, infection, decreased blood flow, or aging.
Testicular cancers may also produce hormones that cause gynecomastia.
Chronic kidney failure and hyperthyroidism are other conditions that are associated with changing the hormonal environment in the body and may be associated with gynecomastia.
Rarely, cancers other than testicular tumors may produce hormones that can cause gynecomastia.

What are the causes of gynecomastia during puberty?

Gynecomastia is caused by an imbalance in the hormone level, in which the level of estrogen (female hormones) increases compared to the level of androgens (male hormones). A type of gynecomastia that occurs in babies who are usually growing and maturing and resolves on its own over time is known as physiological gynecomastia. All people, whether male or female, have female hormones (estrogen) and male hormones (androgens).
During puberty, the level of these hormones may fluctuate and increase at different levels, resulting in a temporary state in which the concentration of estrogen is relatively high.
Studies on the prevalence of gynecomastia in typical adolescents have yielded very mixed results, with prevalence estimates as low as 4% and as high as 69% in adolescent boys. These differences are likely due to changes in what is considered normal and the different ages of the boys in the studies reviewed.
Gynecomastia, caused by transient changes in hormone levels with growth, usually disappears on its own within six months to two years. Sometimes, gynecomastia that develops at puberty and lasts for more than two years is called permanent pubertal gynecomastia.

What drugs cause gynecomastia?

Gynecomastia can be a side effect of many medications, for example:

Spironolactone (aldactone): is a diuretic that has anti-androgenic activity
Calcium channel blockers used to treat high blood pressure (such as nifedipine, Procardia, etc.)
ACE inhibitors for high blood pressure Capopril [Capoten], Enalapril [Vasotec]
Certain antibiotics (eg, isoniazid, ketoconazole [Nizoral, Extina, Xolegel, Kuric], and metronidazole [Flagyl])
Anti-ulcer medications (such as ranitidine [Zantac], cimetidine [Tagamet], and omeprazole [Prilosec])
Antiandrogen or estrogen therapy for prostate cancer
Methyldopa (Aldomet)
Highly active antiretroviral therapy (HAART) for HIV disease, which may cause redistribution of fat, leading to pseudogynecomastia or, in some cases, true gynecomastia.

  • Digitoxin
    Diazepam (Valium)
    Drug abuse (eg, alcohol, marijuana, heroin)
    Lavender oil and tea tree oil, when used in skin care products, have been linked to gynecomastia.

Bodybuilding and its effects on male breast enlargement

For bodybuilders, gynecomastia is a particular concern because the sport is all about looking good. These athletes often take anabolic steroids to maximize muscle growth, which can lead to bodybuilding gynecomastia due to the subsequent hormonal imbalance.Although it is not known exactly how gynecomastia occurs in bodybuilders, it is a far-fetched phenomenon.
A study on bodybuilding gynecomastia claims that between 1980 and 2013 in the United States, 1,574 bodybuilders underwent surgical treatment for the condition.
According to research, it is estimated that 30-40% of men in the entire population experience this disease. In general, gynecomastia is not an unpredictable phenomenon and is likely to be experienced by many male bodybuilders, especially those who use anabolic steroids.

Is there a treatment for bodybuilding gynecomastia?

When bodybuilding gynecomastia appears, it is very important to get it treated by a medical professional before it becomes permanent.
Medications such as aromatase inhibitors or estrogen receptor blockers can be successful in reversing gynecomastia. These medications should be started as soon as possible to be most effective in preventing the progression of gynecomastia.
Reducing the dose or eliminating testosterone replacement therapy is also an option because less testosterone will be available to convert to estrogen.
If gynecomastia persists for approximately one year or more, fibrosis and scar tissue develop and gynecomastia becomes irreversible and requires removal of excess glandular tissue in the male chest area by an experienced surgeon.

What are the methods of diagnosing gynecomastia?

The definition of gynecomastia is the presence of breast tissue with a diameter of more than 0.5 cm in men. As previously discussed, gynecomastia is the presence of actual breast tissue (a gland) that is generally located around the nipple. Fat deposits are not considered real gynecomastia. In most cases, gynecomastia can be diagnosed by physical examination. A detailed medical history is also important, including medication use.
If cancer is suspected, a mammogram may be performed by the doctor. Further tests may also be recommended to help determine the cause of male breast enlargement in certain cases. These tests can include blood tests to check liver, kidney, and thyroid function.
Measuring the level of hormones in the bloodstream may also be recommended in some cases.

What are the complications of gynecomastia?

The most important side effect of gynecomastia is that it can affect your mental health. You may feel embarrassed, or feel anxious or depressed. You can take steps to control these feelings. Talk to your doctor about how you feel about gynecomastia. They can recommend a mental health professional who can help you manage any mental health issues. Also talk to your family and close friends. They know you better and can be the emotional support you need.
Support groups can also help. You will have the opportunity to talk to others who understand what you are going through. Ask your doctor for help finding groups you can connect with.

What drugs are used to treat gynecomastia in men?

Gynecomastia, especially in adult men, often resolves on its own within about six months, so observation is often preferred over specific treatment. Stopping medications and treating existing medical problems or health conditions that are causing male breast enlargement are also the mainstays of treatment.
Medical treatments are available to treat gynecomastia, but information about their effectiveness is limited. No medication has been approved by the FDA for the treatment of gynecomastia. However, medications and pills to treat gynecomastia in men include:
Testosterone replacement has been effective in older men with low testosterone levels, but not in men with normal male hormone levels.
The most effective pill to treat gynecomastia is clomiphene, which can be taken for up to 6 months.
Tamoxifen (Nolvadex) selective estrogen receptor modulator (Nolvadex) reduces breast volume in gynecomastia, but is not able to completely remove breast tissue. This type of treatment is often used for severe or painful gynecomastia.
Danazol is also a synthetic testosterone derivative that reduces the synthesis of estrogen by the testicles. This drug works by inhibiting the pituitary’s release of LH and follicle-stimulating hormone (FSH), substances that drive the sex organs to produce hormones. It is used less often than other drugs to treat gynecomastia in men.