male breast health - gynaecomastia
| Gynaecomastia is a benign proliferation of the glandular tissue of the male breast, causing breast enlargement. It can occur either on one or on both sides. It has to be differentiated from other reasons for enlargement of the breast. Most commonly, this is due to excess fatty tissue only (pseudogynaecomastia). Occasionally, there are benign tumours such as lipomas, dermoid cysts or neurofibromas . Breast cancer is very uncommon in men, and is nearly always associated with a lump lying at the edge of the breast disc, and not immediately behind the nipple. Gynaecomastia is frequent in puberty. It is due to a temporary hormonal imbalance. It has been estimated that there is a degree of gynaecomastia in 30-60% of boys. It can start between 10 and 12 years of age, but is most common between 13 and 14 years. It almost always improves on its own and is usually completely gone by age 16 or 17. If it persists, surgery to remove the extra tissue may be needed. Occasionally there is an indication for hormonal treatment (antioestrogens). The percentage of men who exhibit gynaecomastia increases with age. It may be as high as 24-65% by age 70 – 80. It most cases the cause is unknown, but is assumed to be hormonal. Common causes of gynaecomastia are drug-induced (20%), hormonal imbalance and thyroid, liver or kidney diseases (25%). There are many drugs which can cause the enlargement of breast tissue and a list of these is available. Discontinuation of the medication should resolve the problem within a month. Blood tests can show if there is an imbalance between testosterone and oestrogen hormones. Small amounts of oestrogen are normally found in men, just as small amounts of testosterone are normal in women. Hormone replacement or suppression can be given as needed. Diseases of the thyroid, liver and kidney can cause abnormalities of the body’s metabolism.This can affect the way the body handles hormones and can lead to gynaecomastia. If , after thorough clinical investigations and blood tests, no underlying cause is found it is called idiopathic gynaecomastia. Treatment options are in the first instance to resolve the underlying cause. If this is not possible, treatment depends on how much of a problem it is. Often no treatment is required. If needed, some of the breast tissue can be removed surgically. This produces a small scar in the nipple area. This may be needed with longstanding gynaecomastia which is not improving on its own or with other treatments. With active, newly developed gynaecomastia there may be symptoms of pain or tenderness. In this situation antihormonal therapy (for example low dose tamoxifen) can be helpful. Gynaecomastia is extremely common and there is no reason to be embarrassed by it. Please make an appointment with one of our breast physicians, who can start any necessary investigations. |