What Is Gynecomastia? Causes and Treatments of Male Breast Enlargement

Although chest enlargement in men is often associated with weight gain, it is not always caused by fat. Gynecomastia, which results from enlargement of the breast gland, can appear at different ages, from puberty to adulthood. Understanding the cause is important for determining whether the change in the chest area is temporary and which treatments may be considered.

A Closer Look: What Is Gynecomastia?

Chest enlargement in men is not always caused by weight gain. There may be slight fullness around the nipple or noticeable enlargement of one or both breasts. When this is caused by growth of the breast gland tissue, the condition is medically known as gynecomastia.

This change is usually driven by the effects of hormones on breast tissue. A shift in the balance between estrogen and testosterone, both of which are also present in the male body, can cause the breast gland to grow. Gynecomastia is particularly common during puberty and often resolves on its own. However, it can also develop in adulthood. Although it usually does not indicate a serious health problem, it is important to investigate the cause of breast enlargement that develops later in life.

What Causes Breast Enlargement in Men?

Breast enlargement in men does not have a single cause. Hormonal changes, medications, certain illnesses and an increase in body fat can all affect the appearance of the chest. In true gynecomastia, the underlying mechanism is that the growth-promoting effect of estrogen on breast tissue outweighs the opposing effect of testosterone. This does not necessarily mean that blood estrogen levels are high.

The main factors that can contribute to the development of gynecomastia include:

• Puberty: Temporary changes in hormone levels can cause the breast gland to enlarge.

• Aging: Changes in testosterone levels and an increase in body fat can make gynecomastia more likely to develop.

• Medications: Some hormone medications, drugs used to treat prostate conditions and certain other medicines such as spironolactone can cause gynecomastia.

• Anabolic steroids: Anabolic steroids used to build muscle can disrupt hormonal balance.

• Health conditions: An overactive thyroid, liver disease, kidney failure and certain testicular conditions can be associated with gynecomastia.

Sometimes no specific cause can be found despite investigation. This is known as idiopathic gynecomastia.

The Difference Between True Gynecomastia and Pseudogynecomastia

Not every enlargement of the chest is gynecomastia. Especially in men who have gained weight, increased fat tissue in the breast area can create a similar appearance.

This is known as false gynecomastia or, medically, pseudogynecomastia. In true gynecomastia, the breast gland itself enlarges. In pseudogynecomastia, the main feature is an increase in fat tissue without enlargement of the breast gland.

Several features can help distinguish between the two conditions:

• In true gynecomastia, a firmer, rubbery tissue may be felt beneath the nipple.

• In pseudogynecomastia, the enlargement of the chest is mainly due to fat tissue.

• In true gynecomastia, weight loss may not completely eliminate the enlargement of the breast gland.

• In pseudogynecomastia, losing weight can help reduce chest volume.

However, both conditions can also occur in the same person. It is not possible to tell them apart with certainty based on appearance alone.

What Are the Symptoms of Gynecomastia?

The most noticeable symptom of gynecomastia is enlargement of the tissue around the nipple. This enlargement may be bilateral and symmetrical, or more pronounced on one side. The change in breast tissue may also be accompanied by tenderness or pain. In newly developed gynecomastia in particular, the area behind the nipple may feel tender to the touch.

Some people, however, experience no pain at all. The change in the chest area is noticed only because of its appearance.

However, signs such as a hard, irregular lump, nipple discharge (especially bloody discharge), skin dimpling or swelling in the armpit should not be considered typical features of gynecomastia. In these cases, medical evaluation should be sought without delay.

Does Gynecomastia Go Away with Weight Loss?

One of the most common misconceptions about gynecomastia is that chest enlargement can always be corrected by losing weight.

Weight loss  can help reduce fat tissue in the chest area. In pseudogynecomastia in particular, lowering body fat can noticeably change the appearance of the chest. In true gynecomastia, however, the enlarged breast gland tissue may not disappear completely through weight loss alone.

Similarly, push-ups, bench presses and other chest exercises strengthen the muscles but do not shrink the breast gland. Muscle development can change the overall appearance of the chest, but it is not a treatment for glandular enlargement.

For this reason, it is important for people whose chest enlargement persists despite regular exercise and weight loss to seek medical evaluation.

Does Gynecomastia Go Away on Its Own During Puberty?

Gynecomastia is quite common during puberty. Changes in hormone levels can cause temporary enlargement beneath the nipple. Pubertal gynecomastia often resolves on its own. In many teenagers, the breast tissue begins to shrink within a few months and usually improves significantly within one to three years.

Medication or surgery is not always needed during this period. However, specialist evaluation is necessary if the enlargement persists for a long time, causes severe pain or significantly affects daily life.

The approach is different for gynecomastia that appears in adulthood. In particular, it should be investigated whether newly developing enlargement is related to medications being taken or to an underlying illness.

How Is Gynecomastia Treated? Is Non-Surgical Treatment Possible?

The first step in treating gynecomastia is to determine why the breast tissue has enlarged, because not every case of gynecomastia requires surgery.

For example, in gynecomastia that develops as a side effect of a medication, changing the treatment may be considered if the doctor deems it appropriate. However, prescription medications should not be stopped on your own.

If a hormonal disorder is identified, treatment of that condition is planned first. In temporary gynecomastia during puberty, monitoring may be sufficient.

In some new-onset, painful cases of gynecomastia, a specialist may consider medication. However, some of the drugs used for gynecomastia are not specifically approved for this purpose, and they are not effective in every patient.

In long-standing cases with significant glandular tissue enlargement, non-surgical methods may have limited effect.

When Is Gynecomastia Surgery Needed?

Gynecomastia surgery may be considered when the enlargement of the breast gland has become permanent or significantly affects the person's life.

In particular, if breast enlargement persists despite investigation of the underlying causes and the necessary treatments, surgery may become an option.

The following factors are taken into account when deciding on surgery:

• Long-standing enlargement of the breast tissue

• Noticeable breast volume or change in shape

• Ongoing tenderness or discomfort in the breast area

• The appearance of the chest significantly affecting the person's social life and psychological well-being

• Insufficient improvement with non-surgical approaches

Surgical treatment can be performed not only to change the appearance of the chest but also to correct permanent enlargement of the breast gland.

How Is Gynecomastia Surgery Performed?

The technique used in gynecomastia surgery is determined by which tissues are responsible for the enlargement in the breast area.

When there is excess fat tissue, liposuction may be used. In this method, fat tissue is removed using thin cannulas inserted through small incisions.

In true gynecomastia, the enlarged breast gland tissue may need to be surgically removed. This is usually done through an incision around the nipple.

When there is excess of both fat and breast gland tissue, liposuction and tissue excision can be combined.

If there is significant excess skin in the chest area, the skin may also need to be removed. In such cases, the surgical scars may be more extensive.

Gynecomastia surgery falls within the field of plastic, reconstructive and aesthetic surgery. Before the procedure, the chest structure, skin characteristics and possible surgical risks are assessed.

Recovery After Gynecomastia Surgery

In the first few days after gynecomastia surgery, swelling, bruising and tenderness may occur in the chest area. A feeling of tightness, particularly when moving the arms, is possible.

A special compression vest is usually recommended during recovery. This garment can help support the surgical area and control swelling.

Some people may be able to return to light daily activities within a few days. However, a longer wait is needed before heavy lifting, intense exercise and straining the chest muscles.

It can take several weeks for most of the swelling to subside after surgery. The chest may take months to reach its final appearance.

Surgical procedures also carry risks such as bleeding, infection, fluid accumulation, asymmetry, changes in sensation and wound healing problems. It is therefore important not to miss post-operative follow-up appointments.

The American Society of Plastic Surgeons (ASPS) provides detailed patient information on gynecomastia surgery and recovery.

Can Gynecomastia Come Back After Surgery?

When the enlarged breast gland tissue is removed during gynecomastia surgery, long-lasting results can be achieved. However, it is not entirely impossible for enlargement to recur in the chest area after surgery.

In particular, ongoing hormonal problems, anabolic steroid use or the use of certain medications that can cause gynecomastia may lead to regrowth.

In addition, significant weight gain after surgery can increase fat tissue in the chest area.

For this reason, it is important to maintain healthy lifestyle habits after surgery and to keep any underlying health conditions under follow-up.

Which Doctor Should You See for Gynecomastia?

When breast enlargement is noticed in a man, a family doctor can carry out the initial assessment. If needed, a referral to an endocrinologist or general surgeon may be made.

Endocrinologists play a particular role in investigating hormonal causes. When the enlargement in the breast area needs surgical correction, an assessment can be carried out by specialists in plastic, reconstructive and aesthetic surgery.

Physical examination is fundamental to the diagnostic process. Where necessary, hormone tests, breast ultrasound or other imaging methods may be used.

Although gynecomastia is usually benign, it is not right to regard every case of breast enlargement as purely a cosmetic issue. New-onset, one-sided or rapidly progressing changes in particular need to be medically evaluated.

Sources

• American Society of Plastic Surgeons – Gynecomastia Surgery

• NHS – Gynecomastia

• Mayo Clinic – Gynecomastia: Symptoms and Causes

• Mayo Clinic – Gynecomastia: Diagnosis and Treatment

• Cleveland Clinic – Gynecomastia

Not sure whether it is gynecomastia or fat? Read Gynecomastia vs. Chest Fat: How to Tell the Difference.