Gynecomastia (also known as “man boobs”) is a condition that causes men’s and boys’ breasts to become larger. The term sometimes is spelt gynaecomastia. It is very common in young men following puberty. This results in excess fat or a gland build up over the chest. It makes it look like the female chest. While women opt for breast augmentation treatments to increase their breast size, “Man Boobs” can have a deep psychological impact on boys while they are growing up. Most of the young men don’t know what to do.
The treatment for gynaecomastia usually is surgical. However, according to Singapore General Hospital, 50% to 80% of patients have particularly reduced their breast size by using pharmacologic therapies.
What is Gynecomastia?
Gynecomastia is a medical condition where men develop breast tissues and larger breast size. It can be either “true”, which is the development of the breast gland, or it can be a development of fatty breast tissue which is called pseudo gynecomastia.
Gynecomastia can be also physiological. This is a natural breast development in babies that usually disappears at 6 months of age. Some teenagers also show symptoms of the disease that go away on their own within 2 years.
Gynaecomastia can also be caused as a side effect of using anabolic steroids, which are derivatives of testosterone and the body responds by starting to convert it into estrogen. External effects leading to the disease can also be caused by some medications.
What Causes Gynecomastia?
The causes of that are varied. The development of the breast gland in many men can be normal. Gynecomastia can occur in three age groups – birth, puberty, or old age.
Gynaecomastia can be a result of hormonal imbalance in the body when the female hormone (estrogen) is increased and respectively testosterone levels are decreased. People are often mistaken about this condition, but its symptoms should not be confused with the signs of significant weight gain. It is important to make a difference between the two – in obese people fat deposits are not just around the breasts. The disease swells the mammary glands and the area under the armpits. In Gynecomastia, only their size increases without any change in weight and the rest of the physique.
Being overweight can increase levels of the female hormone, which can cause fatty tissue around the breast. In some cases, weight loss can help but this may not improve the condition.
Newborn baby boys
It is estimated that about 60% to 90% of newborns have transient gynaecomastia, which is most often due to transplacental transmission of estrogen from the mother to the child. Neonatal gynecomastia regresses completely at the end of the first year. At puberty, breast enlargement affects 48-64% of boys, with the 10-year-old being considered the earliest, and the peak of the manifestation is 13-14 years, after which there is a decline at the end of puberty. The highest incidence of this disease is between 50-80 years.
During this period, the boy’s hormone levels vary. Some young men have a low level of testosterone and a high level of estrogen hormone. This can cause breast tissue to grow. Gynecomastia is particularly prevalent in young men going through puberty. However, hormonal fluctuations in puberty tend to resolve themselves within one to two years.
Gynecomastia can be also caused by medications, kidney disease, liver failure, and so on. In about 50 % of cases, no cause for gynecomastia is found.
Types of Gynecomastia
There are several types of Gynecomastia in medicine:
- Type 1 – often called “truth” and affects only the breast glands. This type of disease is associated with genetic abnormalities in the body.
- Type 2 – mixed gynecomastia, in which adipose or glandular tissue predominates. This type of gynecomastia most often occurs with the use of anabolic drugs.
- Type 3 – “false” Gynecomastia. It is caused by an increase in the amount of fat in the breast area. In this case, the breast glands are not hypertrophied.
Symptoms of Gynecomastia
Here are some common symptoms, and what to look out for if you are concerned that you may have Gynecomastia:
- Physical swelling and tenderness of the breast tissue. It can indicate Gynecomastia. Men who suffer from it will almost always have swollen breast gland tissue.
- Hard lumps under your nipples. If you have some of these you may have Gynecomastia. If left unattended, the lump can continue to grow and cause excess swelling. If you do feel a hard lump, make an appointment with a doctor.
- Hormone supplements – If you have been taking hormone supplements, or have experienced latent hormonal changes, you may have Gynecomastia.
- Medications can cause Gynecomastia. If you have been taking anti-androgens to treat some other problems, know that these drugs can cause Gynecomastia. Other drugs that can cause this medical condition, include anabolic steroids, anti-anxiety medications, antibiotics, and heart medications.
Keep a watchful eye on your body, and pay attention to symptom warning signs. If you are worried that you may have gynaecomastia keep this list in mind. For more information about gynecomastia don’t forget to see a doctor.
Gynecomastia in Bodybuilders
In bodybuilders, “man boobs” normally are caused by anabolic steroid use or the ingestion of over-the-counter hormones which are frequently sold in various sport and general nutrition stores.
The development of gynaecomastia in bodybuilders occurs in three stages:
- The first stage – the duration is about four months and with proper treatment, the development of the disease can be stopped, and also the process is reversible.
- The second stage – from 4 to 12 months. The process is still reversible, but very difficult.
- Third stage – the only method of treatment is surgery.
Diagnosis of Gynecomastia
Gynaecomastia is considered as a benign breast condition. It is an increase in the amount of breast tissue but it is not breast cancer. Gynecomastia has a clearly different presentation than breast cancer would in man.
How can you know if you have Gynecomastia or breast cancer? The only way to know it for sure is to see a specialist.
Gynecomastia is usually detected by palpation under the areola of the breast. Diagnosis also includes taking a medical history and doing a physical examination. The patients often need to be tested for their hormonal levels. These include testosterone, estrogen, LH (Luteinizing Hormone), FSH (Follicle Stimulating Hormone), and human chorionic gonadotropin (hCG).
Mammography is one of the main methods for diagnosing Gynecomastia, as it can be used to assess the disease and its stage. Ultrasound is used mainly in adolescence in prepubertal Gynecomastia.
Treatment for Gynecomastia
If “man boobs” are an external effect of the use of the drugs, the first thing that should be done is stopped them immediately. If the disease is in the begging it can be cured with proper diet, lifestyle changes, and certain exercise.
The doctor can also prescribe medications to adjust a hormone imbalance. Nutritional supplements are often used as well.
Sometimes it is necessary surgical treatment to remove the excess breast tissue. The operation can be performed under local or general anaesthesia. After that, swelling and pain may occur, but these are normal reactions of the body. The fatty will disappear in the first weeks, but the final result of the operation is visible after about 3 to 6 months. After that, patients should not be exposed to the sun or exercise.
Surgical Treatment of Gynecomastia
The surgical treatment depends on whether there is excess fat or whether there is an excess gland on the chest or a little bit of both. What it entails is liposuction if it is only fat or liposuction in addition to gland excision which involves a very small incision around the nipple to take the excess gland out the following liposuction.
The surgery can be done under local anaesthesia with sedation. It’s done as a daycare surgery following which you leave the hospital by evening. Pressure garments are usually advised to be worn for three to four weeks following the procedure.
Gynecomastia surgery can be also performed under general anaesthetic. Each operation carries risks associated with anaesthesia. The decision about the type of anaesthesia is made according to the specifics of the procedure, the patient’s preferences, and the surgeon’s recommendations. These and other aspects will be discussed with you before giving your consent to the operation.
Depending on the patient’s needs, as well as the technique used by the surgeon, incisions in mammoplasty can be made along the edge of the areola or within the armpit. At the same time, the chest will be sculpted and outlined to restore the natural look of the body.
Possible side effects of gynecomastia surgery are bleeding, infection, and poor healing, loss of sensitivity.
Gynecomastia Surgery Recovery
Recovery can take several weeks, and the result is noticeable after about 3 – 6 months. If the operation is performed by a qualified plastic surgeon it will result in significant, almost immediate recovery, with minimal scarring.
After the operation, your doctor will require you to wear a special elastic vest for about 1 month (24 hours a day), which will help minimize swelling and maintain the new contour of the chest. Bandages are also used to cover the incisions and they must be changed frequently.
After one week you need to visit the clinic for a check-up.
As much as possible, avoid stretching, strength training, or lifting heavy objects for 6 weeks after the procedure. Keep in mind that in rare cases, you may experience pain when wearing a seat belt in a vehicle, so resume driving or travelling when the pain has passed (this may take several weeks).
In case you have other questions about recovery after gynecomastia surgery, do not hesitate to make an appointment with your surgeon.
Anxiety before surgery for gynecomastia is completely natural. Tell your surgeon how you are feeling and ask any questions you may have about the risks involved in gynecomastia surgery. The surgeon, as well as the medical staff, will take full care of your stay in the clinic, as well as your safety.
How Much Does Gynecomastia Surgery Cost in Singapore?
The cost of gynecomastia surgery in Singapore depends on the complexity of the condition which determines the surgical plan. Some patients can be treated with a minimally invasive technique while other patients may require skin excision.
The best option is to seek an in-person consultation with a plastic surgeon with sufficient experience in male chest surgery.
Gynecomastia surgery in Singapore may cost between $5000 and $15000. It depends on the condition of the patient and the stage of the condition. On average, the price is about $5550.
Also, this condition and its treatment may be covered by your Medisave or insurance, so do make sure you bring this up to your plastic surgeon and your insurer when you have decided to go for the procedure.