Gynecomastia

At Riley Children’s Health, plastic surgeons treat young boys with symptoms of gynecomastia. Gynecomastia is enlarged or swollen breast tissue caused by a hormone imbalance.

Gynecomastia is a common condition that affects boys. It occurs when breast tissue swells and enlarges in one or both breasts. It can happen at any age, but it is most common during periods of hormonal changes, such as puberty. This condition can affect one or both breasts and may cause discomfort, emotional distress, and embarrassment. Although the condition is not medically concerning, it is important to understand its causes, symptoms, and available treatment options.

Symptoms of Gynecomastia

Symptoms vary between patients and may be more severe in some patients. It is also important to note that gynecomastia is different from having excess fat in the chest area, which is sometimes referred to as "pseudogynecomastia." Gynecomastia specifically involves the growth of breast tissue, not just fat.

Breast Enlargement: The most noticeable symptom of gynecomastia is swelling of the breast tissue. This may affect one or both breasts and it can vary in size.
Breast Tenderness: The breast area may feel tender or sensitive to touch, which can cause discomfort.
Firm or Rubbery Tissue: You may notice a firm or rubbery mass of tissue beneath the nipple, which can sometimes be painful.
Uneven Growth: In some cases, gynecomastia may affect only one breast, leading to uneven growth. This can sometimes make the condition more noticeable.
Nipple Discharge: Though rare, some cases of gynecomastia may include nipple discharge. If this occurs, it should be evaluated by a physician to rule out other conditions.

Causes of Gynecomastia

Gynecomastia is usually caused by an imbalance between two hormones—estrogen and testosterone. While estrogen is typically known as a female hormone, men also produce small amounts of it. When the levels of estrogen are too high relative to testosterone, it can lead to the development of breast tissue. Other common causes of gynecomastia include:

Hormonal Changes: Hormonal shifts during puberty can cause gynecomastia. For example, during puberty, boys may experience temporary breast enlargement as their hormone levels fluctuate. In most cases, this resolves on its own over time. However, if breast enlargement is present for more than a year, it is unlikely to go away on its own.
Medications: Certain medications can cause gynecomastia as a side effect. These include drugs used to treat conditions like high blood pressure, heart disease, ulcers, and prostate cancer. Some antidepressants, anti-anxiety medications, and steroids can also lead to breast tissue growth.
Health Conditions: Some health problems can cause hormonal imbalances that lead to gynecomastia. These include conditions like liver disease, kidney failure, thyroid problems, and tumors that affect hormone-producing glands.
Substance Use: Alcohol, marijuana, and anabolic steroids can contribute to the development of gynecomastia. Other drugs, such as amphetamines, heroin, and certain herbal products, can also affect hormone levels and increase the risk.
Obesity: Excess weight can lead to higher levels of estrogen in the body, which can cause breast tissue to grow.

In many cases, the cause of gynecomastia may not be entirely clear. If you experience breast swelling or other symptoms, it’s important to talk to a physician to determine the underlying cause.

Diagnosis

Diagnosing gynecomastia usually begins with a physical exam. Your doctor will examine your breast tissue and may ask about your medical history, medications, and lifestyle habits. In some cases, additional tests may be needed to rule out other causes of breast enlargement, such as breast cancer or a hormonal disorder. Common diagnostic tests include:

Blood Tests: These tests can check hormone levels and identify any imbalances that may be causing breast tissue growth.
Mammogram or Ultrasound: Imaging tests like mammograms or ultrasounds can provide a closer look at the breast tissue to ensure there are no underlying issues, such as tumors. This is very rare.
Biopsy: In rare cases, a biopsy may be performed to check for the presence of cancerous cells.

Treatment Options for Gynecomastia

Treatment for gynecomastia depends on the severity of the condition and the underlying cause. In many cases, gynecomastia may go away on its own, especially if it is related to puberty or temporary hormonal changes. However, if the condition persists for more than a year, or causes significant discomfort, there are several treatment options available:

Observation: For mild cases, your doctor may recommend simply monitoring the condition to see if it improves over time. This is often the first step, especially if the gynecomastia developed recently and is occurring with puberty.
Medications: If gynecomastia is caused by a hormonal imbalance, certain medications may help adjust hormone levels. These medications can either lower estrogen levels or increase testosterone levels in the body.
Lifestyle Changes: In cases where gynecomastia is linked to obesity, alcohol use, or certain drugs, making lifestyle changes can be effective. Losing weight, reducing alcohol intake, or stopping the use of certain substances may help reduce breast tissue growth.
Surgery: If gynecomastia lasts for more than one year or does not improve with other treatments, surgery may be an option. It is important to know that the best time for surgery is when you are done growing, but there are some exceptions to this, which your doctor can discuss with you.

Surgical options for gynecomastia

There are three main surgical options for gynecomastia. Surgery is usually considered when other treatments have not been successful, or when gynecomastia has been present for over a year. It is very unlikely to go away when it has been present for over a year.

Liposuction alone: This can be done if the tissue is mostly fat, but this is unusual.
Direct excision of breast tissue through a periareolar incision: This procedure removes excess breast tissue through an incision between the areola and the surrounding skin. This scar heals and is hardly noticeable. Many doctors combine this with some liposuction.
Mastectomy: This surgery removes the breast gland tissue, as well as extra skin. This results in large scars across the chest, just beneath the breasts. During this procedure, the nipple is removed and replaced on the chest as a graft.

Surgery risks and recovery

As with any surgery, there are risks associated with gynecomastia surgery. These can include infection, scarring, changes in nipple sensation, and asymmetry of the chest. However, the risks are generally low, and most patients are satisfied with the results.

Recovery from gynecomastia surgery typically takes 6 weeks. Patients are usually advised to avoid strenuous activity during the initial recovery period and may need to wear a compression garment to reduce swelling and support the chest area as it heals.

Key Points to Remember

Gynecomastia is a common condition that can affect adolescent boys. While it is not usually a serious medical issue, it can be uncomfortable and impact self-esteem.
Understanding the symptoms, causes, and available treatment options can help you make informed decisions about managing the condition.
If your child is experiencing symptoms of gynecomastia, it’s important to speak with a physician. At Riley Children’s, we offer a range of diagnostic and treatment services to address gynecomastia and improve quality of life.

Locations

In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.