BENIGN BREAST DISEASES

GYNAECOMASTIA

What is gynaecomastia?

Gynaecomastia is a non cancerous (benign) overgrowth of male breast tissue.  It can affect either one or both breasts. It is usually reversible.

What is the incidence of gynaecomastia?

Gynaecomastia is very common.  It occurs in at least 35% of men at some time in their life. 

What are the types of gynaecomastia?

True gynaecomastia is when both stromal and the ductal tissue of the breast are present.

Pseudogynaecomastia has a lot of fatty tissue and has a similar appearance. Both types can present together.

What are the causes of gynaecomastia?

Gynaecomastia is due to a relative increase in a hormone called estrogen in the body.

It can be due to:

Physiological causes

Pathological causes

Drug related

Physiological gynaecomastia is also called primary gynaecomastia

It is often self limiting. It has 3 peaks. It occurs in the neonatal age group (newborns up to one month of age), puberty (10 -16 years of age) and older age (50- 80 years of age) group.

Puberty

Gynaecomastia occurs in about 30 - 60% of boys aged 10-16.  Puberty usually starts once you reach your teenage years. Some of you may notice change when you are as old as ten.  To start with there is a rise in the levels of estrogen and testosterone.  You may notice that your breasts are tender to touch. One or both breasts may become noticeable. Gynaecomastia of puberty is due to imbalance of the hormones testosterone and estrogen.  As you grow older the levels of testosterone (male sex hormone) settle and counteract the effects of estrogen.  The breast/s becomes smaller and flattens out. In some of you it may take longer to flatten out. 

What is the treatment of physiological gynaecomastia due to puberty?

It is often self limiting. Reassurance is all that is required.  After discharge if your breast/ breasts become larger or increasingly painful or if you develop new symptoms you should go back to your GP. 

Older age group (50 – 80 years of age)

Testosterone levels begin to fall and there is an increase in the body fat level and therefore an increase in the estrogen levels.  This makes the breast or breasts larger.

Pathological causes

Conditions of the body that cause either an increase in the estrogen levels or a decrease in testosterone levels can cause enlargement of the breast tissue. 

Causes of increased estrogen

Testicular cancers

Cancer of the lung

Liver failure

Increase in thyroid hormone

Diseases of the adrenal gland

Causes of decreased testosterone

Renal failure

Chromosomal abnormalities

Bilateral torsion of testes

Viral infection of testes

What is the treatment for gynaecomastia due to pathological cause?

Treatment of the underlying cause is recommended

Which drugs cause gynaecomastia?

1 Recreational drugs Alcohol, Cannabis, Heroin

2 Drugs used for heart problems and for high blood pressure Digoxin, Spiranolactone, Captopril, Enalapril,  Amiodarone, Nefedipine, Verapamil

3 Antiulcer drugs Cimetidine, Ranitidine, Omeprazole

4 Antibiotics Ketoconazole, Metronidazole, Minocycline

5 Psychoactive agents Tricyclic antidepressants, Diazepam, Phenothiazines

6 Others Domperidone, Metoclopramide, Penicillamine, Phenytoin, Theophylline

7 Drugs used in the treatment of Prostate cancer

What is the treatment for drug induced gynaecomastia?

You will have to change to an alternative medication or withdraw the medication after discussion with your GP.

How is gynaecomastia investigated?

Tests are done to exclude cancer of the breast and or to find out the underlying cause for gynaecomastia.

What happens in the breast centre?

After a thorough history taking, physical examination of the breast, arm pits, abdomen and testicles are performed. Ultrasound examination of the breast is performed. You may have a mammogram (X ray) of the breast. The specialist may perform a needle test to take some cells or perform a biopsy and take a sample of tissue which is then sent for examination under the microscope. 

If there are concerns about pathological causes or you may have blood tests to check the function of the liver, kidneys, and thyroid or hormone levels to check for cancer of the testicles.

How is gynaecomastia managed?

Once cancer is excluded and if there is no underlying cause for gynaecomastia, reassurance is all that is needed. If you are symptomatic with pain it is treated by either:

Surgery or

Medical management

What are the drugs used in the management of pain?

Tamoxifen

Danazol

Arimidex

What are the surgical options?

Liposuction

Surgical excision

Mammotome excision (handheld vacuum assisted mammotome procedure under the guidance of ultrasound)

For more information contact: sasi@mybreastcare.org

This information sheet is aimed at men who have been examined by a breast specialist and found to have gynaecomastia (non cancerous) condition. It is not a substitute for the advice of a qualified doctor. It is intended to provide information for better understanding and reassurance.