Gynecomastia is defined as benign, excessive breast development in men. It is derived from the Greek words gynec (feminine) and mastos (breast). Some studies suggest that one in three men has gynecomastia. While it can be observed in infancy and old age, gynecomastia most frequently occurs during adolescence. According to a study conducted in our country, the prevalence in adolescent males is 34.6%. Although gynecomastia is not harmful to health, it causes distress and embarrassment for the individual. Long-standing gynecomastia does not regress spontaneously. It requires medical treatment and, if necessary, surgical intervention.

What are the Causes of Gynecomastia?

Gynecomastia results from irregularities or imbalances in estrogen and testosterone hormones. In other words, if the amount of testosterone in the body decreases or the amount of estrogen increases, gynecomastia can occur. This hormonal change can have many causes. Some of these changes are natural and not caused by another underlying medical condition. Other cases of gynecomastia may be due to another disorder.

1. Natural Hormonal Changes:

As is known, testosterone and estrogen are hormones that control sexual characteristics in humans. Testosterone determines male characteristics such as muscle mass and body hair, while estrogen controls female characteristics such as breast development. However, contrary to popular belief, men also synthesize a small amount of estrogen. When this testosterone/estrogen balance in men shifts towards estrogen, gynecomastia can occur.

Gynecomastia in Infants: More than half of male infants are born with large breasts due to estrogen passed from their mothers. The swollen breast tissue disappears spontaneously within two to three weeks after birth. Gynecomastia During Puberty: The appearance of gynecomastia due to hormonal imbalances observed during puberty is a frequently observed condition. In 90% of cases, swollen breast tissue spontaneously returns to its original state between six months and two years. Gynecomastia in adults: The incidence of gynecomastia increases again between the ages of 50 and 69. One in four men in this age group experience gynecomastia.

2. Medications That Cause Gynecomastia:

Many medications can cause gynecomastia. Some of these include:

Anti-androgen medications used to prevent prostate enlargement or treat prostate cancer
Anabolic steroids and androgens
Some antiretroviral drugs used in AIDS treatment
Certain anxiety medications
Tricyclic antidepressants
Some antibiotics and ulcer medications
Chemotherapies
Some heart medications such as calcium channel blockers

3. Drugs and Alcohol

Alcohol
Amphetamines
Marijuana
Heroin
Methadone and similar substances can cause gynecomastia.

4. Health Problems:

Many health problems can disrupt the normal balance of hormones and cause gynecomastia.

Hypogonadism: Gynecomastia can be observed in health problems that lead to impaired testosterone production, such as Klinefelter syndrome or pituitary gland insufficiency. Tumors: Tumors located in organs such as the testes, adrenal glands, and pituitary gland can disrupt the balance of sex-determining hormones. Hyperthyroidism: Excessive secretion of thyroid hormone can cause gynecomastia. Kidney failure: Gynecomastia is a common problem in hemodialysis patients. Liver failure and cirrhosis: Since irregularities in hormones are observed in liver problems, gynecomastia may occur. Malnutrition and starvation: When the body is excessively starved, testosterone levels decrease, but estrogen levels remain unchanged. Therefore, gynecomastia may occur.

5. Herbal Products

Tea tree and lavender oils, found in shampoos, soaps, and lotions, are thought to potentially cause gynecomastia due to their low estrogenic activity.

Who is at Risk of Gynecomastia?

Adolescents
The elderly
Those using anabolic steroids and androgens to improve athletic performance
Those with liver, kidney, or thyroid disease and Klinefelter syndrome are at risk of gynecomastia.

What are the Symptoms of Gynecomastia?

Symptoms observed in the breasts include:

Swelling
Pain
Tenderness
Fluid discharge from one or both nipples.

How is Gynecomastia Diagnosed?

Manual examination of both breasts is important for diagnosing gynecomastia. A hard, walnut-sized mass can be felt behind the nipple. These examination findings should be confirmed by performing a breast ultrasound on the patient. The examination and ultrasound findings are guiding factors in diagnosis and treatment planning.

What are the Treatment Options for Gynecomastia?

Before starting gynecomastia treatment, it should be evaluated whether the patient has an underlying hormonal disorder. Therefore, if an individual suspects the presence of gynecomastia, they should first consult an endocrinology specialist.

Gynecomastia treatment options are determined according to the type of gynecomastia. There are many classifications of gynecomastia. In adolescents, the course and response to treatment of gynecomastia are measured using the Nydick classification. In this classification, the type of gynecomastia is determined according to the size of the glandular tissue disc located under the brown ring (areola) of the nipple. In adolescents with a disc diameter smaller than 4 cm, it is more appropriate to inform the patient and wait for spontaneous resolution. However, if the patient’s complaint persists for more than 4 years or if the clinical findings that bother the patient increase, there is an indication to start treatment. Medical treatment can be applied if the disc diameter in the patient is between 4-6 cm. Surgical intervention is recommended for cases where the disc diameter is larger than 6 cm.

Medical treatments are tailored to the patient’s age, hormonal levels, and underlying medical conditions. The most commonly used medication is Tamoxifen. It shows its effect in approximately two weeks. Patients should be closely monitored monthly during medication use. This medication is not effective in adults with gynecomastia for more than a year.

Gynecomastia Surgery

Surgical intervention is the most effective and definitive method for treating gynecomastia. The type of intervention is determined by the surgeon after examinations. Different methods can be used for different classifications of gynecomastia. For example:

In glandular gynecomastia, firm breast tissue predominates and needs to be surgically removed.
In mixed gynecomastia, there is excess glandular and fatty tissue; surgery and liposuction (fat removal) are used together. In fatty gynecomastia, fat tissue predominates, and it can be treated with liposuction alone.

Another classification evaluates the size of the breast tissue and excess skin. The type of surgical intervention is determined accordingly.

After Gynecomastia Surgery

The recovery process after gynecomastia surgery varies depending on the surgical technique. If VASER or laser liposuction techniques are used, the recovery process is quite comfortable. In gynecomastia caused by fat tissue, effective results are obtained after approximately 3 weeks following VASER and laser liposuction applications, and the person can comfortably perform many activities.

In cases requiring surgical intervention, the operation is usually performed under general anesthesia, although local anesthesia may be preferred in some cases. The person can be discharged on the same day after the operation. Due to general anesthesia, the person may need to be kept under observation for one night, but this is not very common.

It is normal to see edema and swelling in the area after gynecomastia surgery. These formations disappear spontaneously within the first week. Mild muscle pain may occur after the operation. Resting for 3 days after gynecomastia surgery and avoiding excessive movement of the arms and shoulders is important for the patient’s comfort and healing process. On the 3rd day after the operation, showering can be done (provided it doesn’t take too long), and light walking can be done.

Gynecomastia Constriction

A gynecomastia constriction is a medical product that should be used after gynecomastia surgery. One of the most important points to pay attention to after gynecomastia surgery is the continuous use of this constriction. This constriction, which is very easy to use, should be worn immediately after the operation and continuously for the period determined by your doctor (2-3 weeks). After the third week, it is beneficial to wear the constriction only during the day, especially when performing strenuous activities. This period is approximately 6 weeks.