Gynecomastia

Also called man boobs and enlarged breasts in males, gynecomastia is a common condition that can affect infants, teenagers, and adults alike. In gynecomastia, males develop hormonal imbalances, which lead to the growth of the breast glandular tissues. Gynecomastia can affect one or both breasts. If the growth happens only on one side, the condition is called unilateral gynecomastia. If the growth is on both sides, the condition is called bilateral gynecomastia.

When unilateral or bilateral gynecomastia develops, the individual’s chest starts to look like female breasts. As the condition progresses further, the growth becomes visible through clothes and also starts to cause emotional and mental stress.

Typically, gynecomastia is not a major health problem, but it can be difficult for men to cope with it. Sometimes, it can cause pain, discomfort, and nipple sensitivity, and the man may feel embarrassed.

As gynecomastia can be triggered by a variety of factors, its diagnosis involves taking a detailed medical history of the patient to identify the potential cause of the tissue growth. A physical exam of the chest is also done. The doctor palpates the chest to evaluate the tissue growth and analyze if the patient has true gynecomastia or pseudo-gynecomastia. In true gynecomastia, mostly breast glandular tissues are present in the chest, whereas, in pseudo-gynecomastia, mostly fat tissues are present.

Further testing is recommended to determine the grade of gynecomastia and the ideal treatment approach. The common tests done for gynecomastia patients are listed below:

• Blood Test: A detailed blood test is done to evaluate the hormonal levels in the blood, including testosterone, estradiol, LH, and hCG. The detailed blood test report can indicate the cause of the enlarged breast tissue.
• Mammography: The primary imaging test done for gynecomastia diagnosis is mammography. It accurately distinguishes the composition of the tissue growth and confirms whether the patient has true gynecomastia or pseudogynecomastia.
• Tissue Biopsy: A biopsy is only recommended for gynecomastia if the mammography is inconclusive. It helps to determine the tissue composition and rule out the possibility of breast cancer.

Depending on the results of these tests, the doctor creates a customized treatment plan for the patient.

The most suitable method of gynecomastia treatment is determined by its cause. The cause of gynecomastia is usually different in males during infancy, puberty, and adulthood. In infancy, the males have higher levels of estrogen due to the mother’s estrogen, and the growth usually disappears within 2-4 weeks.

During puberty, gynecomastia is triggered by hormonal fluctuations and often resolves within 6 months to 2 years without intervention. However, in adults, enlarged male breasts develop due to an underlying condition.

In puberty and adulthood, gynecomastia may or may not go away on its own and may persist for years. The need for treatment is determined by the severity of the condition, and the options include the following:

• Liposuction: This approach is preferred for gynecomastia treatment if the tissue composition is mostly fat. It involves using a liposuction cannula to break down the fatty deposits and extract them using suction. Liposuction is the ideal approach for pseudo-gynecomastia.
• Gland Excision: This treatment method is more suitable for true gynecomastia. It involves excising the breast glandular tissues precisely using a scalpel. This procedure is slightly more invasive than liposuction surgery.
• Male Breast Reduction: Medically called reduction mammoplasty, this is a combined approach of liposuction and gland excision techniques. As most males have both fat and glandular tissues, male breast reduction surgery allows the surgeon to effectively remove all tissues that make the male chest appear like breasts.

Surgery is generally not the first choice for gynecomastia. It is only recommended when patients have tried medical management but failed to get the desired results.

In most cases, gynecomastia surgery is an elective procedure. Males choose to get surgery to get rid of the female-like chest and restore the masculine features.

Gynecomastia surgery, or male breast reduction surgery, has numerous advantages for patients dealing with enlarged breasts. Some key benefits include the following:

• Restore Masculinity: Gynecomastia surgery helps patients regain their masculine chest. The glandular tissues are removed effectively, and the chest is flattened.
• Improve Self-Image and Confidence: Having a female-like chest can be embarrassing for males. The surgery fixes that and helps male to regain their self-confidence and feel better about themselves.
• Better Physical Health: After removing the enlarged breast tissues, males can participate in physical activities and sports without feeling awkward.
• Resolve Physical Symptoms: The overgrown breast tissues often cause pain and discomfort in males. With surgery, these back, neck, and shoulder pain and posture issues will resolve.
• Clothing Options: Most men with man boobs avoid well-fitted clothes to hide their chest. But the surgery will give them the freedom to wear proper-fitted clothes without worrying about their chest’s appearance.

Thus, gynecomastia surgery has both psychological and physical benefits for the patients.

If you wish to undergo gynecomastia surgery, it’s important to understand that even though the surgery is elective, plastic surgeons use well-defined criteria to determine a patient’s eligibility for the procedure.

A male is considered an ideal candidate for gynecomastia surgery if he meets the following conditions:

• If gynecomastia cannot be treated through alternative medical treatments.
• If the male is healthy and doesn’t have any life-threatening condition or illness that can impair the healing process.
• The male should not be a smoker or a drug user.
• The male should have a positive outlook and specific goal about improving the symptoms of gynecomastia.
• He should have a relatively normal weight and a physically healthy body.
• His breast development has stabilized.

Once the doctor confirms that you meet the standard eligibility criteria, the surgery can be planned as required.

The basic guidelines that the doctor will advise you to follow when you are planning to undergo gynecomastia surgery involve the following points.

• List down all the medications you are currently taking, including blood thinners, NSAIDs, herbal supplements, vitamins, or other prescription medicines. There is a high possibility that the doctor may have to adjust your medications or ask you to stop taking certain medications to avoid complications during and after the surgery.
• Refrain from smoking or consuming tobacco or nicotine entirely at least 4 to 6 weeks prior to the surgery date. The components present in cigarettes and tobacco affect the natural healing abilities of the body and delay recovery.
• Drink plenty of water before the day of surgery and eat light. However, you may have to avoid drinking and eating eight hours before the surgery.
• Ask someone to accompany you on the day of surgery as you won’t be able to drive.
• Wear loose and comfortable clothing as you will have to wear them after the surgery. Tight clothes will press against your skin and may cause irritation or discomfort.

Even before the surgery, you will have to make some lifestyle changes, such as quitting smoking completely. There can be risks like pneumonia, heart attack, and a slower healing process if you continue smoking. So, instead of sticking to your old unhealthy habits, make smart lifestyle choices to keep yourself healthy after getting in shape after gynecomastia surgery.

To prepare you for gynecomastia surgery, the nurses will insert an IV line and sterile the surgery site. The procedure is carried out in the following steps:

• General anesthesia or IV sedation is used to numb the surgery site. Antibiotics are also given through an IV line to reduce the risk of infection during surgery.
• The surgeon first marks the incision line and uses a scalpel to make the incisions.
• Through the incision, the liposuction cannula is inserted to break down the fat tissues in the chest region. The tissues are extracted using suction.
• After removing the fat tissues, the surgeon will use the scalpel to remove the glandular tissues. Once the surgery is complete, the patient is transferred to the recovery room for observation and then moved to a general/private/sharing ward as the effects of anesthesia wear off.

Gynecomastia surgery usually takes around 40 to 60 minutes to complete and is performed on an outpatient basis. It means that you will get discharged on the same day of surgery. Before discharge, detailed post-op care instructions and a follow-up guide will also be provided to you.

Immediately after gynecomastia surgery, you will be transferred to an observation room, where your vital signs will be monitored for a few hours. After that, you will be transferred to the private/sharing/general ward while your discharge papers are prepared.

As you wake up and the effects of anesthesia wear off, you can expect to feel slightly disoriented, confused, nauseated, itchy, or have muscle pain. You will also feel pain and discomfort in the treated area, which will be managed through pain medications. A compression vest is also given to the patient to support the chest muscles and reduce swelling. A drainage tube will also be placed beneath the chest.

Gynecomastia surgery is performed on an outpatient basis. Thus, you will be discharged on the same day of surgery. Before discharge, the doctor or his/her team will provide detailed post-op care instructions and a follow-up schedule.

Typically, 2-3 follow-up appointments are needed after gynecomastia surgery. The first follow-up is done within 7 to 10 days, where the sutures are removed, the medication dosages are adjusted, and the doctor looks for potential signs of complications. The next follow-up is done after 2 weeks to monitor the recovery and update the patient accordingly. The third and last follow-up is done within 4 to 6 weeks. This follow-up schedule may vary for patients depending on their healing abilities.

For every patient, the gynecomastia surgery recovery timeline varies. In general, most patients recover within 2 to 4 weeks. But your recovery and gynecomastia surgery success rate will depend on how well you take care of your overall health during the recovery period.

Generally, 1 week after gynecomastia surgery, the side effects, including swelling, redness, bruising, etc., will start to disappear, and you will notice improvement in the chest shape and contour. By the 2nd week, you will be able to move around more comfortably, but you still need to take several precautions. Once the sutures are removed, and the wound starts to heal, you will be able to start work and resume most activities.

Here are some aftercare tips to help you during gynecomastia surgery recovery:

• Take all the prescribed medications, including painkillers, antibiotics, and anti-inflammatory medicines, as directed by the doctor without fail.
• Change the wound dressing as instructed and wash your hands every time before and after.
• Take adequate rest in the initial days after surgery to allow the body to heal properly.
• Don’t strain or put undue pressure on the chest muscles during the first 2 weeks.
• Take a healthy and balanced diet to improve the body’s healing abilities.
• Avoid smoking and drinking alcohol until the recovery is complete, as they can interfere with the healing process.
• Avoid direct sunlight to prevent hyperpigmentation or darkening of the skin around the treated area.
• Look out for the signs of complications, such as fever, persistent swelling, extreme pain that can’t be managed with medicines, blood or pus discharge from the incisions, etc., and contact the doctor right away.
• Add exercises into your routine after recovery to maintain a stable weight and improve the chest contours.

Following the doctor’s instructions is crucial to ensure that your recovery is smooth and the outcome of the surgery is as desired.

You should always prefer consulting a plastic or cosmetic surgeon for gynecomastia treatment instead of a general surgeon. They take a more personalized and minimally invasive approach to treat gynecomastia and ensure the surgery’s outcome is aesthetically pleasing.

To find the best plastic or cosmetic surgeon (also called gynecomastia doctor), you should follow the steps below:

• Take a referral from your general physician, friends, family, colleagues, and other acquaintances, and make a list of the doctors that you would like to consult.
• Check each doctor’s credentials, including education, certifications, experience, specialization, etc. Make sure that the doctor is well-trained and has a valid practice license.
• Go through the patient reviews and testimonials to check the doctor’s reputation among the patients and the quality of care provided by him/her.
• Also, check the hospital with which the doctor is affiliated and whether the facility has modern technology and amenities to provide best-in-class care and services.
• Have a consultation with the doctor and see how he/she communicates with you. Try to ask as many questions as possible and see how well the doctor responds.

Choosing the doctor is one of the most important decisions that you will have to make in regard to gynecomastia treatment. So, make sure that you don’t rush the decision and pick a surgeon who makes you feel confident about undergoing male breast reduction surgery.

Gynecomastia surgery cost in India ranges from Rs. 35,000 to Rs. 1,00,000. This is an estimated price range, and the actual cost of treatment primarily depends on the severity of the condition. If the patient has grade 1 gynecomastia, the surgery will cost around Rs. 35,000 to Rs. 60,000. As the condition progresses to grades 2, 3, and 4, the cost of treatment increases.

The cost of gynecomastia treatment depends on the following factors:

• The surgeon’s fee
• Hospital-related expenses
• Diagnostic tests and evaluations
• Prescribed medications
• Post-op care and follow-ups

One thing that should also be noted is that gynecomastia treatment costs can be covered under insurance only in specific circumstances. If you are undergoing surgery for cosmetic reasons, the health insurance provider will not approve your claim request to cover the cost. If you are considering surgery for medical reasons, you need to provide clinical documents signed by a certified doctor to get the treatment covered by insurance. To clearly understand the terms and conditions of your health insurance policy regarding gynecomastia surgery cost coverage, it’ll be best to talk to the insurance provider.

As the body starts to heal after gynecomastia surgery, you can notice the following things:

• The swelling around the chest area will start to subside over time.
• The bruising and redness will also start to fade, and the normal skin color will appear.
• As the incision heals, they will become less noticeable. Initially, they may appear darker, but over time, with proper care, they will also fade away.
• You will notice that the pain in the chest region is almost gone, and you don’t have to rely on pain medications as much as before.
• The range of motion in the arms will also improve once the stitches are removed and again when the incisions have healed.
• The sensations in the chest region that were absent will also be back in most patients.

These things indicate that the body is healing properly and you can get back to your normal life.

Some precautions to be taken after gynecomastia surgery include the following:

• Don’t poke, rub, or scratch the incision site as it causes infection or worsening of the scars.
• Whenever you need to change the bandages or dressing, wash your hands with an antibacterial soap.
• Avoid wearing tight clothes as they can rub against the wound and cause irritation.
• Don’t eat spicy and oily foods that have null nutritional value.
• Don’t go out in the sun or allow direct sunlight contact with the treated area until the wound heals.
• Avoid performing any kind of physical activity that can put a strain on the affected area.
• Also, avoid drinking alcohol and smoking as much as possible, as they can impair healing abilities.

Until the recovery is complete, you’ll be advised to stay in touch with the doctor and ask questions if you have any doubts or concerns. The doctor and his/her team will help you as required to ensure your recovery is smooth.

Typically, gynecomastia surgery is safe when performed by a skilled and experienced surgeon. However, the side effects of surgery are consistent and experienced by all patients to different extents. Some common risks and side effects of gynecomastia treatment are:

• Bleeding
• Swelling
• Bruising and redness
• Mild to moderate discomfort
• Scarring

These side effects often resolve on their own but may persist for a longer time. If you fail to comply with the doctor’s instructions, some complications may also arise, such as

• Hematoma or seroma
• Chest asymmetry or irregularities
• Infection
• Poor wound healing
• Unfavorable or abnormal scarring
• Changes in sensation in the chest region

Generally, the risks and complications associated with gynecomastia surgery can be mitigated with proper care.

Making lifestyle changes after gynecomastia treatment is crucial for patients, especially during the recovery period. After recovery is complete, these changes will further improve the overall health of the patient, physical and mental, and also be helpful in preventing recurrence. Some lifestyle changes that you’ll have to make are listed below:

• Wearing Compression Garments: Your surgeon will likely provide you with a compression garment to wear post-surgery. It might be hard to continue wearing the garment 24x7, but it is crucial as it helps reduce swelling, provides support, and aids in proper healing.
• Maintaining Good Hygiene: Keep the surgical area clean and dry to prevent infection. Many patients don’t touch or clean the surgical site, fearing that they may tear up the stitches or it might hurt. But you can use a soft, clean cloth and warm water to gently clean the area, and it will significantly reduce the chances of infection. The same hygiene needs to be maintained while bathing during recovery.
• Avoiding Strenuous Activities: For a specified period after surgery, you'll need to avoid vigorous physical activities, heavy lifting, and exercises that engage the chest muscles. Your surgeon will provide guidance on when it's safe to resume these activities. Until then, strictly follow the guidelines and don’t push yourself to the limit just because you feel slightly better.
• Diet and Nutrition: Maintain a balanced diet to support healing and minimize the risk of complications. Adequate nutrition is essential for tissue repair. Even after recovery, a good and healthy diet will reduce the chances of developing pseudo-gynecomastia.
• Scar Care: The scar care will start after the incisional wound has healed. Follow your surgeon's instructions regarding the same, which may include applying topical treatments or silicone gel sheets to promote optimal scar healing.
• Avoid Smoking and Alcohol: Smoking and excessive alcohol consumption can interfere with the healing process. It's best to abstain from these substances during your recovery. After recovery, the doctor may still advise you to keep control of these habits, especially alcohol intake, and it can increase the chances of recurrence.
• Sun Protection: Immediately after the surgery, you will have to develop a habit of using sunscreen and take other measures to prevent direct sunlight contact with the treated area. Protect surgical scars from direct sunlight to prevent hyperpigmentation or darkening. Try to avoid going out much in the first month, and after that, use proper protection.

Complete healing and the final results usually take time. So, be patient and listen to the doctor’s advice. Adhere to these instructions to get the best outcome.

There are several alternative treatments available that claim to treat gynecomastia, but there is no scientific evidence available to support these claims. Some of the popular gynecomastia treatment methods are explained below.

• Ayurveda
• Ayurvedic treatments for gynecomastia focus on balancing the doshas (Vata, Pitta, and Kapha) and addressing underlying causes. Some common practices included in Ayurveda for gynecomastia treatment are given below.
1. Dietary Changes: Ayurveda often recommends a diet tailored to your dosha imbalance. Generally, foods that help balance excess Kapha dosha and reduce fatty tissue may be suggested.
2. Herbal Supplements: Three common herbal products are recommended to the patient for a combined effect on the fat and glandular tissues. These include the following-
3. Triphala: A combination of three fruits known for detoxification.
4. Guggul: Used to improve metabolism and reduce fat tissue.
5. Varunadi Kashayam: A herbal decoction used for urinary disorders.
6. Lifestyle Modifications: The lifestyle changes that are suggested by Ayurvedic experts include exercise, which includes specific yoga asanas or exercises that target the chest area, and stress management to help regulate the hormones.
7. Detoxification: Panchakarma therapies like Virechana (purging) or Basti (enema) may be suggested for detoxifying the body, which may help to reduce fat deposits.
8. Massage Therapy: Herbal oils and massages, such as Udvartana, may be used to stimulate circulation and reduce fat accumulation.

Ayurveda treatment for gynecomastia is usually personalized according to the individual’s requirements. If you consult an Ayurvedic doctor, they may recommend a different approach for you than others.

Homeopathy aims to treat the underlying causes of gynecomastia and improve hormonal balance. Some common homeopathic remedies that may be considered include the following:

• Calcarea Carbonica: This remedy is often prescribed for overweight individuals with a tendency toward excessive sweating and sensitivity to cold. It may help address glandular swellings.
• Thuja Occidentalis: This remedy is considered when there are warty growths or glandular swellings on the chest. It's often recommended for individuals with a history of vaccination.
• Conium Maculatum: This remedy is used when there is hard glandular swelling in the breasts, often with a feeling of pressure or tension.
• Ruta Graveolens: It is suggested when there is a feeling of soreness and bruising in the breast tissue.
• Graphites: This remedy may be considered for individuals with a tendency toward obesity and skin eruptions, along with gynecomastia.
• Baryta Carbonica: It's prescribed for delayed development in young boys or older individuals with a feeling of weakness and mental sluggishness.
• Silicea : This remedy is indicated when there are glandular swellings with a tendency to suppuration (formation of pus).

You should remember that homeopathy is not an exact science, and these remedies should only be tried after consulting a doctor.

There are no specific home remedies that can address the root causes or provide a cure, but some lifestyle changes and strategies may help manage the condition or alleviate discomfort:

• Diet and Exercise: Maintaining a healthy diet and engaging in regular exercise can help reduce overall body fat, which may, in turn, decrease the appearance of gynecomastia if excess fat is a contributing factor.
• Weight Management: If you're overweight, losing excess weight through diet and exercise may help reduce breast size.
• Avoid Triggers: If certain medications or substances are suspected of causing gynecomastia, consult an expert doctor to discuss alternative treatments or medications.
• Compression Garments: Wearing compression shirts or vests can temporarily minimize the appearance of enlarged breasts by providing support and compression.
• Stress Reduction: Stress management techniques, such as meditation, yoga, or deep breathing exercises, may help balance hormones and alleviate some symptoms.
• Limit Alcohol and Recreational Drugs: Reducing or eliminating the consumption of alcohol and recreational drugs may be advisable since these substances can contribute to gynecomastia.

It should be kept in mind that these measures will not resolve the condition or reverse the growth. But they can act as a preventive measure to halt the progression of the condition.

Several medications are prescribed by the doctor to address the underlying cause of hormonal imbalance that ultimately leads to enlarged breast development in males. However, there is no specific USFDA-approved medicine for gynecomastia that can treat the condition.

Some common medicines that may be prescribed in certain cases are:

• Selective Estrogen Receptor Modulators (SERMs): Many believe that Tamoxifen (a commonly prescribed SERM) medicine is recommended for gynecomastia, but it only blocks the estrogen receptors in the breast glandular tissues, which halts further growth.
• Aromatase Inhibitors: Two commonly prescribed aromatase inhibitors are Anastrozole and Letrozole. These medications inhibit the conversion of testosterone into estrogen, which can be beneficial in cases of gynecomastia caused by elevated estrogen levels.
• Testosterone Replacement Therapy (TRT): Also called hormone therapy, if gynecomastia is associated with low testosterone levels, TRT may be recommended to restore hormonal balance.
• Danazol: This medicine is a synthetic hormone that can suppress estrogen production and slow down the progression of gynecomastia.

The above-listed medicines should not be taken without a prescription as they can have side effects.