Introduction 

The common male problem in an Aesthetic clinic, Gyanecomastia, is truly Pseudogynaecomastia with only fatty tissue and minimal glandular tissue. The condition is a part of the co existing Obesity disorder and is rarely, a standalone entity. The treatment options shall include an approach to answer the issue of obesity as a whole, not rest contented with surgical removal of the enlarged breasts alone. What is seen and what is treated is just a tip of the iceberg. 

Gynaecomastia, an innocuous condition, that affects 35-70% of male population immediately after birth, during adolescence and old age is rarely brought to notice as the sufferer makes all attempts to hide it as the condition brings with it a sense of shame and pain in public places and mental suffering. Herein starts the search for the treatment. Medical and multifaceted surgical options evolved over centuries with the current opinion being fat removal by anyone form of liposuction and the gland removal by direct excision. Gynaecomastia, is increased breast tissue in males composed of glandular and fatty tissue. 

Physiological gynaecomastia of puberty that normally regresses with age tend to stay back being sustained by the modern lifestyle changes. Processed foods and environmental pollution of air and water, the cosmetics used on the body like deo odorants, perfumes and toiletries, synthetics and chemicals have contributed to explosions of generalised obesity. With this generalised obesity, the tendency to hold back excess fat in the breast developed. This clearly shows the reason for higher incidence of (pseudo) Gynaecomastia of late. Hormonal imbalance due to reasons stated above, aggravate the situation. Gynaecomastia is part of the generalised obesity and it is more fat and little gland. 
However, this condition does not have any harmful effect on the body, but it can cause distress emotionally. Men may lose their self-confidence and they can be psychologically affected by this.

What Causes Gynaecomastia?

It is a type of hormonal imbalance that results in the growth of the male breast tissues. The ratio of oestrogen v/s androgens gets altered and causes the enlargement of the breasts. For this condition to occur, the amount of oestrogen increase in the body, or the amount of testosterone drops. Sometimes it can be the combination of both.

There are certain diseases that may contribute to gynaecomastia and they are as follows:

Kidney diseases

Liver disease

Drop in testosterone levels

Certain medications such as methadone, medications for HIV or treating prostate cancer

Certain tumours caused in male sex organs such as cancer of the Leydig cells or the Sertoli cells resulting in deprivation of androgen levels

Conclusion: 
True Gynaecomastia that requires surgical treatment is not so uncommon. What is commonly believed to be gynaecomastia is truly Pseudo gynaecomastia with a co exiting clinical picture of obesity, high BMI, sedentary life and wrong lifestyle. Surgical treatment by laser liposuction under Tumescent Anaesthesia gives very good results with high patient satisfaction and negligible post operative complications. Gland fragmented with laser can be extricated thro  same entry point without sub areolar incision.

Gynaecomastia (Enlarged Breasts In Men): Causes and Treatments

Gynecomastia is a hormonal condition that causes swelling of the breast tissues in men and boys. This condition usually arises as a result of hormonal imbalance. Breasts do not form in the same pattern in males as they do in females but all males are naturally born with tiny quantities of the breast tissues. The male body produces the testosterone hormone, which plays an important role for growth during the stage of puberty. However, they also make the hormone estrogen that is instrumental for developing sexual growth in females.

When a male passing through the stage of puberty makes lesser amounts of testosterone then there is an imbalance of the hormones. As a result of the higher amount of estrogen present in men leads to swelling of the breast tissues.

Cause of imbalance-

Aside from the common reason which is the lesser production of testosterone, there are a few other reasons that can put into effect this imbalance. They are-

  Injury to the testicles that are responsible for producing testosterone
  Obesity which leads to greater production of estrogen
  Taking illegal drugs
  Liver disorder
  Failure of the kidney
  Thyroid problems that result in throwing off your hormonal balance
  Medications that you might be taking for illnesses such as cancer, depression, heart disorders and ulcers

Treatment of Gynecomastia

The treatment of gynecomastia involves a general surgery which reduces the size of breasts by flattening and enhancing the contours of the chest. If in very severe cases the weight of the breast tissue has sagged and stretched the areola region, then the areola size can be improved surgically by reducing the excess skin.

  Mammaplasty

Plastic surgery, known as Mammaplasty, is also sometimes put into effect in order to treat the condition of gynecomastia.

  Liposuction

In the case of liposuction, the procedure of the treatment first starts with a set of medications that need to be consumed. These medications help to reduce pain during the surgery. There are two ways of taking this medication, either through intravenous sedation or via general anaesthesia. The liposuction technique involves the insertion of a hollow tube with the help of several incisions. Liposuction technique is generally prescribed if the cause of gynecomastia is excess of fatty tissues. During the procedure, the cannula or the tube will be moved back and forth in order to loosen up the excess fat. This fat is then removed via vacuum suction.

  Excision Technique

The excision technique is prescribed when the glandular breast tissue needs to be removed in order to rectify gynecomastia. In this procedure, the nipple will either be repositioned to a manlier contour or the areola size will either be lessened. In some other cases, the general surgery of gynecomastia can also involve a combination of both the excision technique as well as the liposuction technique.

Gynecomastia is a condition that can severely damage the emotional balance of a man and lessen their self-confidence. It has been also seen that many men suffering from this condition tend to avoid physical intimacy or sexual activities as a result of body-image issues. Therefore, treatment is highly recommended for those suffering from gynecomastia.

Gynecomastia - Knowing The Causes & Treatment Of It!

Gynecomastia is a condition where the tissues of the breasts swell in a boy or men. This is caused by the imbalance of testosterone and oestrogen. It might affect one or both the breasts depending on the level of hormonal imbalance. Although not considered as a serious condition, Gynecomastia can be a difficult condition to cope up with. There are multiple treatment options and surgery is one of them. In many cases, this condition goes as abruptly as it appeared. For cases that are complicated and difficult to get rid of, doctors suggest a medical procedure get rid of the condition.


Symptoms of Gynecomastia:
Some common symptoms of Gynecomastia include tenderness of breasts, swollen breast gland, pain in the breasts, discharge from the nipple etc.


Causes of Gynecomastia:
There could be many causes of this disease. If the condition is witnessed in babies, it could well come from the mother due to an overdose of oestrogen. Gynecomastia also appears during puberty resulting in the breast to swell up. The condition can again crop up after the age of 50 due to hormonal changes.
Certain medications can be a reason of Gynecomastia. Some of the common medications include certain antibiotics, anti-anxiety related medications, chemotherapy shots, HIV patients receiving HAART, cardiovascular medications such as Lanoxin, anabolic steroids etc.
Certain drugs such as heroin, alcohol, methadone, marijuana, Amphetamines etc.
Certain health conditions such as hypogonadism, hyperthyroidism, liver cirrhosis, ageing, certain tumours, failure of the kidney malnutrition etc.


Risk Factors Of Gynecomastia-
Certain risk factors of gynecomastia include older age, use of certain steroids, adolescence and other medical conditions such as Klinefelter's syndrome, tumour related to hormonal fluctuation and disease related to thyroid.
Diagnosis:
A doctor typically checks the history of drugs along with the health condition of the patient. He might also take a look at the health of the extended family. A careful tissue evaluation of the genitals, breast and abdomen are done. This is followed by a physical exam followed by prescribing certain tests such as mammograms, complete blood work, CT scan, biopsy of the tissue, MRI scan etc.


Treatment:
Most people suffering from Gynecomastia see a significant regression with periodic treatment. If however the condition arises from an underlying cause such as cirrhosis and malnutrition, a doctor suggests 2 option- medications and surgery:


Medications: Certain medications that are known to be helpful for breast related cancers are known to be effective in this condition. Some common examples of these drugs include evista, arimidex and soltamox.
Surgery: Only after exploring all medical options a doctor suggests surgery. There are 2 procedures namely mastectomy and liposuction. The latter removes the fat cells of the breast and the former removes the breast gland tissue.     


Gynecomastia - Is Surgery The Best Option?

Swollen breast tissues in men or boys caused by hormonal (testosterone and estrogen) imbalances is called gynecomastia. Both breasts or one breast, can be affected by gynecomastia. At any point in life, from birth to puberty, even in adulthood, you might develop gynecomastia. Most of the times, gynecomastia is caused by hormonal imbalances, but there might be some underlying causes as well.
Gynecomastia is normally not a serious condition, but it can be difficult to deal with the pain and embarrassment.

It can be cured with surgery or medication, if it doesn't go away on its own.

Symptoms and signs of gynecomastia include:

Enlarged glands in the breast tissue
Tenderness in the breast
The causes that trigger gynecomastia include:

Hormonal changes: Testosterone and estrogen control the sexual development in men and women respectively. Estrogen is not a hormone that only women produce; men produce it too. When the production of testosterone and estrogen are thrown out of balance, gynecomastia occurs.
Medication: Certain medications such as anabolic steroids, androgens, HIV/AIDS medicines, antibiotics and chemotherapy can cause gynecomastia.
Drugs and alcohol: Substances such as alcohol, marijuana, amphetamines, heroin and methadone cause gynecomastia.
Health condition: Certain factors, such as aging, hypogonadism (hormonal disorder), hyperthyroidism (overactive thyroid gland), tumors, kidney failure, cirrhosis, liver failure, malnutrition and starvation can lead to gynecomastia.
Herbal products: Essential oils derived from plants such as lavender or tea tree, used in lotions or shampoos, have weak estrogenic actives. They have been said to cause gynecomastia.
Gynecomastia can be cured either with medication or surgery. Surgical options for gynecomastia are, however, limited.

Treatment

There is no definitive medical treatment. The main answer for Gynecomastia is -SURGERY. It is a daycare procedure in most situations. It is done by a Surgeon, usually, a Plastic surgeon does a better job. 

Anesthesia- Either Local or General anesthesia is given to make it painless. 

Procedure-Through a small incision in the areola, the swelling is removed by both Liposuction of the Fat part and Excision (removal) for Breast gland part. As the incision is through the areola, the final scar is hardly visible. In extensive swellings, skin also needs to be removed, where in a scar around the areola border is visible. 

Recovery- usually can go back to work in 2-3 days time.

Treating Gynecomastia (Enlarged Breasts in Men) With Surgery

Swollen breast tissues in men or boys caused by hormonal (testosterone and estrogen) imbalances is called gynecomastia. Both breasts or one breast, can be affected by gynecomastia. At any point in life, from birth to puberty, even in adulthood, you might develop gynecomastia. Most of the times, gynecomastia is caused by hormonal imbalances, but there might be some underlying causes as well.
Gynecomastia is normally not a serious condition, but it can be difficult to deal with the pain and embarrassment.
It can be cured with surgery or medication, if it doesn't go away on its own.

Symptoms and signs of gynecomastia include
a) Enlarged glands in the breast tissue
b) Tenderness in the breast

The causes that trigger gynecomastia include
1. Hormonal changes: Testosterone and estrogen control the sexual development in men and women respectively. Estrogen is not a hormone that only women produce; men produce it too. When the production of testosterone and estrogen are thrown out of balance, gynecomastia occurs.
2. Medication: Certain medications such as anabolic steroids, androgens, HIV/AIDS medicines, antibiotics and chemotherapy can cause gynecomastia.
3. Drugs and alcohol: Substances such as alcohol, marijuana, amphetamines, heroin and methadone cause gynecomastia.
4. Health condition: Certain factors, such as aging, hypogonadism (hormonal disorder), hyperthyroidism (overactive thyroid gland), tumors, kidney failure, cirrhosis, liver failure, malnutrition and starvation can lead to gynecomastia.
5. Herbal products: Essential oils derived from plants such as lavender or tea tree, used in lotions or shampoos, have weak estrogenic actives. They have been said to cause gynecomastia.

Gynecomastia can be cured either with medication or surgery. Surgical options for gynecomastia are, however, limited. The two surgical options for gynecomastia include:
a) Liposuction: Liposuction only removes the fat from the breast, not the breast gland tissue. It has fewer complications, there is limited or zero blood loss and there is less distortion of the nipple.
b) Mastectomy: Mastectomy removes the gland tissues in the breast. The surgery uses minimal incisions to remove the gland tissue. Also, it involves less time to recover.

Treating Gynecomastia With Surgery

The development of a girl s breast at puberty is a major differentiating factor between the silhouette of a boy and a girl. However, sometimes, men too can develop breast tissue. This condition is known as Gynecomastia. While it is not fatal or very harmful to a person s overall health, it can cause emotional distress and affect a person s self-confidence.

Gynecomastia can be triggered by a number of factors including diet, lifestyle, hormonal imbalances etc. One of the most surprising causes of this condition is milk. This is because milk is considered to be rich in oestrogen. When talking of milk, it can be categorised as organic and non-organic milk. In order to increase the amount of milk, a cow can produce they are often injected with hormones. Milk collected from cows who have received such treatment is known as non-organic milk while milk collected from cows who have not received any form of treatment to boost milk production can be termed as organic milk. Non-organic milk may also have a higher than normal IGF-I level. This refers to an insulin-like growth factor that aids in the development of breast tissue.

The main reason milk consumption is encouraged is for its high calcium levels. However, you can get your calcium from other natural sources as well. Green leafy vegetables like spinach, kale and bok-choy are very rich in calcium and the calcium from these vegetables can be very easily absorbed by our bodies. Thus, skipping your glass of milk will not give you weak bones.

Gynecomastia can be treated. Increasing your intake of cruciferous vegetables like broccoli and cauliflower can help absorb and remove oestrogen from the digestive tract before it goes into the blood stream. Spices like turmeric can increase testosterone levels and help balance hormones. Phytoestrogens like flax seeds and soy can also help treat gynecomastia by minimising oestrogen levels and reducing cholesterol.

Two ayurvedic herbs that can increase the production of testosterone and thus, help maintain a balance between oestrogen and testosterone are tribulus terrestris and cordycep. Red clover can also help reduce oestrogen levels. Sarsaparilla is yet another ayurvedic herb that can help treat this condition by strengthening muscles.

In addition to these dietary changes and herbal medicines, one must also exercise to reduce fat tissue in the chest area. Lifting weights or chest bench presses are ideal exercises to strengthen chest muscles and reduce gynecomastia.

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Drinking Milk - Cause Male Breast (Gynecomastia)?

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