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July 24, 2024
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A common misconception about gynecomastia, or "man boobs," is that the condition is caused solely by excess fat. In truth, breast tissue alone is the primary cause of gynecomastia. Excess fat is a secondary component, followed by skin laxity.
Many patients assume that liposuction alone will fix the issue—they may have been ill-advised by inexperienced doctors—as liposuction rarely produces the results patients seek to effectively get rid of the medical condition.
Dr Ivan Puah details the various presentations of gynecomastia, including its basic anatomy, various gynecomastia grades, and what gynecomastia looks like in men of different ages.
The Anatomy Of Gynecomastia
Gynecomastia is a common medical condition affecting approximately 60% to 70% of the male population. Anatomically, the male breast is similar to the female breast, extending from the second to the sixth anterior rib. The sternum is the medial border, and the mid-axillary line is the lateral border.
Ideally, the male chest is flat with prominent pectorals. In a patient with gynecomastia, the male breast will have a more pyramidal shape with feminine features. Excess glandular tissue and fat surrounding the breast are the primary classifications of gynecomastia.
Several reasons cause this tissue to develop, including hormonal imbalance, genetics, and side effects of medications.
Grades of gynecomastia
Gynecomastia Grade I
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Gynecomastia Grade II
Gynecomastia Grade III
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Gynecomastia Grade IV
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Can Gyno Go Away? Stage 2 Gyno, for example
Unfortunately, gynecomastia does not resolve on its own, regardless of the stage. Even in cases like Stage 2 gynecomastia, where there is moderate enlargement of breast tissue with excess skin, the condition persists. Once the breast tissue and glands enlarge, they do not shrink or revert to their original size without surgery.
How Does Gynecomastia Look Like In Men Of Different Ages
Gynecomastia may happen at different phases of their lives. Causes may vary, and the treatment to be recommended is also dependent on their age.
Gynecomastia can look different in men of different ages, and its appearance can vary based on various factors such as the condition's severity, cause, and duration.
Here's how gynecomastia may look like in men of different ages:
Neonatal gynecomastia
This occurs in newborn babies and is usually caused by the presence of maternal hormones in the baby's body. In most cases, the breast enlargement resolves on its own within a few weeks or months after birth.
Pubertal gynecomastia
Due to hormonal changes, this type of gynecomastia is common in boys during puberty. The breast tissue may appear slightly enlarged and tender, and the areola may become more prominent. In most cases, pubertal gynecomastia resolves independently within a few months or one to two years.
Adult gynecomastia
Gynecomastia in adult men can vary in appearance based on its severity and duration. In mild cases, the breast tissue may appear slightly enlarged, while in more severe cases, it can become noticeably enlarged, saggy, and droopy. Gynecomastia can occur unilaterally (one breast) or bilaterally (both breasts).
Senescent gynecomastia
This type of gynecomastia occurs in older men and is often due to age-related hormonal changes. The breast tissue may appear enlarged, saggy, and droopy, and the areola may become larger.
Gynecomastia in the Adolescent/Teenage Years
According to the National Institutes of Health (NIH), 50% to 60% of adolescent males suffer from gynecomastia. In boys, temporary gynecomastia may occur during puberty due to changes in hormone levels. The decrease in testosterone compared to estrogen is the leading cause.
Some boys may start experiencing the symptoms of gynecomastia as early as 10, peaking between the ages of 13 and 14. At age 17, around 10% will continue to experience gynecomastia. In most cases, the issue goes away on its own by the time they reach 21.
Hormonal changes
Adolescent gynecomastia is caused by an imbalance of hormones, specifically an increase in estrogen (female hormone) and a decrease in testosterone (male hormone).
Breast Enlargement
Adolescent boys with gynecomastia have enlarged breast tissue that is tender to the touch. The areola may also become more prominent. Gynecomastia can occur on one breast (unilateral) or both breasts (bilateral).
Psychological Impact
Adolescent gynecomastia can have a negative impact on self-esteem and body image, which can affect his mental health.
Treatment options
In cases where the gynecomastia persists or causes significant psychological distress, gynecomastia surgery is recommended.
Gynecomastia in the 20s
Gynecomastia that has remained undiagnosed and untreated is likely the reason behind men who experience the condition well into their 20s. Other causes of gynecomastia besides undiagnosed from teens gynecomastia include:
Underlying health conditions
Gynecomastia can be a symptom of an underlying health condition, such as a hormonal disorder or certain types of cancer.
Medications and drugs
Certain medications and drugs, such as anabolic steroids or anti-androgen drugs, can cause gynecomastia.
Men in this category generally have Grade I and II gynecomastia. Those who are overweight or obese most often have Grades III and IV. Puffy nipples are common and more pronounced. As the breast tissue grows, it will hang over the crease of the breast, creating a rounded appearance—the opposite of the typical sculpted, masculine look.
Young men affected by the condition may find themselves challenged physically and mentally. They may not wear tight-fitting clothes and resent looking at themselves in the mirror. The "man boobs" appearance may also be more prominent if there have been significant fluctuations in weight over the years.
Gynecomastia in the 30s
Signs of laxity may already appear for men in their 30s. Fluctuations in weight can worsen the situation, resulting in a more severe form of gynecomastia. This can negatively affect the individual as they become more self-conscious and reclusive. This may impede their social and professional opportunities, resulting in declining mental well-being.
Causes of gynecomastia at this age may also be due to medications, drugs or anabolic steroid abuse. Hormonal imbalance could still be an underlying factor as well.
Hormonal changes
Like other age groups, hormonal changes can cause gynecomastia in men in their 30s. This can include an increase in estrogen levels, a decrease in testosterone levels, or both.
Breast enlargement
Men with gynecomastia in their 30s may notice enlarged breast tissue that can feel tender or sore to the touch. The breast tissue may also be firm or rubbery. Due to fluctuations in weight over the years, signs of loose skin start to appear.
Medications and drugs
Certain medications and drugs, such as those used to treat depression or high blood pressure, can cause gynecomastia. Substance abuse, including alcohol and marijuana, can also be a factor.
Health conditions
Gynecomastia can be a symptom of underlying health conditions such as liver disease, thyroid disorders, or tumours.
Psychological impact
Gynecomastia can have a negative impact on a man's self-esteem and body image, which can affect his mental health.
Gynecomastia in the 40s
In their 40s, men experience fluctuating weight and hormones, which affect their bodies. The skin starts to stretch and become lax, among other things.
Gynecomastia is a common breast lesion. Hence, a proper diagnosis must be made to accurately determine the issue. Certain medications may also be a cause. These include:
- Steroids
- Antidepressants
- Cardiac, epilepsy and anti-ulcer medicines
During a consultation, it is therefore highly advisable for a patient to inform the doctor of the medication that they are taking.
Breast enlargement
Men with gynecomastia in their 40s may notice enlarged breast tissue, which can feel tender or sore to the touch. The breast tissue may be firm or rubbery.
Other causes besides hormones
Certain medications and drugs, such as those used to treat prostate cancer or heart conditions, can cause gynecomastia.
Health condition
Gynecomastia can be a symptom of underlying health conditions such as liver disease, thyroid disorders, or tumours.
Lifestyle factors
Obesity and excessive alcohol consumption can also increase the risk of gynecomastia in men in their 40s.
Psychological impact
Gynecomastia can hurt a man's self-esteem and body image, which can affect his mental health.
Gynecomastia in the 50s & During Andropausal
Andropause can begin in the 40s for men, but it is more common in their 50s that it is more prevalent. Andropause is when male hormone production, especially testosterone, declines. Side effects include hair loss, insomnia and gynecomastia.
The drop in testosterone levels leaves the body unable to balance out the estrogen that's being produced, and this can lead to the appearance of gynecomastia. Additionally, severe hyperthyroidism can also cause gynecomastia.
How to Tell if Gyno Is Getting Worse?
Seek medical help immediately if you notice any nipple discharge, increasing pain and tenderness, or a growing rubbery lump beneath your areola. These symptoms require prompt medical attention.
What Is the Fastest Way to Get Rid of Gynecomastia?
To date, gynecomastia surgery is the only proven effective method for treating gynecomastia. Non-invasive treatments, such as fat freezing, may help reduce chest fat, but they do not address the underlying issue of enlarged glandular tissue. Once male breast tissue enlarges, it is unlikely to return to its original size. This makes surgery the most reliable option for completely resolving gynecomastia.
Gynecomastia surgery with 360°GTD: A Customised Approach For All Types Of Gynecomastia Conditions
Each gynecomastia case is unique. The surgical approach must be versatile to address the issue effectively.
The 360°GTD® technique, developed by Dr Ivan Puah is an unique surgical approach to effectively treat gynecomastia as it factors in each individual's unique condition such as gynecomastia grade, size of enlargement, degree of loose skin and muscular curvature of the chest. With this technique, small strategically placed incisions are made, and post-surgical drainage tubings are not required, which reduces the risks of post-surgical infection.
For men whose gynecomastia issue is compounded with excess chest fat, Dr Puah's MDC-Sculpt®️ Lipo Technique enables him to remove fat efficiently and sculpt the chest for a more defined appearance.
Gynecomastia, as evident, can occur in men and boys at any age. Accordingly, the approach to addressing the issue must be as unique as the individual situations and needs. Finding a doctor who truly understands this and is experienced and qualified is essential to seeking help.
