What is Gynecomastia?

Gynecomastia is also called enlarged male breasts or man boobs. It is a benign enlargement of breast glands.

What most people don’t know is that both men and women have breast glands. While in women they are very well developed, in men they are only rudimentary. 

But not Always. Let me explain.

During puberty, a boy undergoes many physiological changes. Changes in voice and a sudden increase in height are external changes caused by the changing internal hormone balance. 

In girls, the breast glands begin to develop under the influence of rising female hormones. Sometimes in men, the transient imbalance in the hormonal levels may stimulate male breast gland growth. In up to 60 per cent of boys, there is a noticeable increase in the male breast tissue to varying extents. The development of excess breast tissue ceases as soon as the hormone levels stabilize. And as the chest enlarges the glands flatten out and become imperceptible. 

However, in a small percentage of boys undergoing puberty, the glands develop to such an extent that they remain perceptible even in adult life. 

This remnant, small female breasts-like presence is called gynecomastia. Gynecomastia glands develop from breast tissue but they are not the same as normal breast glands. They are firm and fibrous. 

Enlargement of breasts on both sides is more common, called Bilateral Gynecomastia. Enlargement on one side only is called unilateral gynecomastia. 

The most common cause of gynecomastia is developmental. That means male breast development happens on its own as I have explained above (it is not your fault). This is also called Pubertal gynecomastia. 

Gynecomastia is not a disease. You may consider it an aesthetic problem.

Other causes of gynecomastia include diseases and medications. Although gynecomastia is not a disease it may be a symptom of one. The breast gland grows in the presence of female hormones hence any disease which increases the levels of female hormones in a male can likely cause gynecomastia. Also, all the drugs and medications that affect the normal balance of male vs female hormones can also result in gynecomastia.

What does gynecomastia look like?

Gynecomastia looks like a small breast gland which has just started to develop. There is a palpable lumpish glandular tissue structure behind the nipple and areola. Sometimes the nipples may also be slightly enlarged. Breast enlargement may be present on only one side or on both sides. Boys often complain of pain in the nipples or tenderness to touch when gynecomastia is actively growing. 

What are the different grades of Gynecomastia?

Gynecomastia is divided into 4 grades depending on the size and extent of the gland. 

Grade 1 is when there is puffiness of the nipple-areola complex. That is the gland is limited to the area behind the areola.

Grade 3 is when the gland spans over the entire chest. That is the gland extends from the border of the chest bone to the sides.

Grade 2 is between grade 1 and grade 2.

Grade 4 is when the gland extends like grade three and then grows even more so that there is extra skin that would need to be removed.

The reason to divide it into grades is obviously for better communication between academics and documentation. Still, it also serves as a guide to the type of procedure that may be required to correct gynecomastia. Grade 1 is small and will require excision with or without Liposuction of the chest. Grade 2 and Grade 3 both will require excision and Liposuction for chest contouring.

Grade 4 will require an additional step to remove any extra skin.

How to know if you have gynecomastia?

The answer is pretty simple you will know it when you see it. Just hold your hips and press on them to tighten the chest muscle. With the opposite hand feel the breast between fingers and thumb. You can roll the glandular tissue between the fingers and it feels rubbery. 

A better way is to ask your plastic surgeon. Other than a physical examination your surgeon might order a couple of radiological tests or an ultrasound to confirm the diagnosis.

What is pseudo-gynecomastia?

There is another condition that increases the chest skin and makes it look like gynecomastia and that is obesity. But there is no gland development, there is only excess fat. Fat deposition in obesity or chest skin laxity after massive weight loss mimics gynecomastia and is called pseudo-gynecomastia. If there is only fat then weight loss with dieting and exercise will gve good results. A Liposuction can also be done to expedite the results. If there is extra skin then the surgical treatment is almost similar to the surgery for grade 4 gynecomastia. The extra skin needs to be removed.