What causes Gynaecomastia?

Gynaecomastia, often referred to as “Man Boobs”, is enlarged breast or chest tissue in men and is very common. According to Healthdirect.gov.au, as many as 2 out of 3 men over the age of 50 may have the condition. Whilst Gynaecomastia is also common in young men during puberty, it generally disappears with age.

Gynaecomastia is most often caused by a hormonal imbalance between testosterone and estrogen; elevated levels of estrogen can suppress the release of testosterone and is responsible for the growth of glandular breast tissue. Excess fat around the chest can also give a similar appearance to Gynaecomastia and can be treated in a similar manner with surgical treatment. 

What does Gynaecomastia look and feel like?

The spectrum of gynaecomastia can vary from very mild to extreme. Also, gynaecomastia can manifest in one or both breasts.

Mild gynaecomastia typically appears as a firm, rubbery lump or mound of tissue beneath the nipple. It feels like a small button-sized growth that can be tender to the touch. It can often look like a slight breast enlargement and may be noticeable as a visible bulge under the nipple area when pressed on – this patient typically has no excess skin and normal areolar size but has a notable “lump” deep to the areolar.

In contrast, severe gynaecomastia is when the person develops fully formed pendulous breasts. This patient therefore has significant amounts of excess skin, enlarged areolar, and a large volume of breast tissue.

Obviously, the treatment required will be dictated by the severity of gynaecomastia.

Could Gynaecomastia be breast cancer?

Gynaecomastia is benign (not cancer) and typically manifests at a younger age and in both breasts.

Breast cancer in men is considerably less common than breast cancer in women. According to the Cancer Council, there were approximately 200 men diagnosed with breast cancer in 2023, with an average age of 71 years.

Symptoms of breast cancer in men are similar to those in women and include:

• A breast lump in one breast only – although having breast cancer in both breasts at the same time is possible
• Thickening of the breast tissue
• Dimpling of the skin of the breast
• Change in the shape of the breast or nipple
• A discharge from the nipple
• A painful area
• Swollen lymph nodes in the armpit area

What causes Gynaecomastia?

In most cases, Gynaecomastia is caused by an imbalance in testosterone and estrogen hormones, resulting in an increase of breast gland tissue in men. Pseudogynecomastia has a similar appearance to Gynaecomastia but is an increase in fat, not breast tissue, around the chest and can also be treated using non-surgical and surgical interventions.

Whilst enlarged male breasts are caused by hormonal changes or weight gain, this does not rule out other possible underlying causes

• Puberty: Hormone changes during puberty can cause Gynaecomastia in adolescent boys – the commonest cause
• Aging: Hormone changes in men aged over 50 can cause Gynaecomastia
• Medications: Antidepressants, antibiotics, chemotherapy, prostate cancer medicines, ulcer or cardiovascular medicines, and more
• Illegal drugs: Anabolic steroids, heroin, marijuana, and more
• Herbal products: Tea tree oil and lavender oil
• Diseases: Liver disease, kidney disease, lung cancer, testicular cancer, and more
• Genetic disorders: Klinefelter syndrome, where male babies are born with an extra X chromosome
• Other conditions: Thyroid disorders, obesity, injury, and more

If any doubt exists regarding the underlying cause of the gynaecomastia, then a referring to a specialist endocrinologist (hormone doctor) should be provided.

Can Gynaecomastia go away with exercise?

If Gynaecomastia is caused by obesity (Pseudogynecomastia), losing weight through diet and exercise may help reduce it. However, if the Gynaecomastia is caused by a hormonal imbalance, exercise is unlikely to have an effect. Since excess breast tissue develops due to an imbalance between estrogen and testosterone, physical activity alone cannot correct the underlying hormonal issue.

Furthermore, if true Gynaecomastia exists, and a fuller figured male decides to lose weight, then as the fatty tissue slowly goes away the underlying breast tissue remains, and this is typically when the person notices that they have Gynaecomastia.

Treatments for Gynaecomastia

Non-Surgical Treatments for Gynaecomastia

In mild cases of Gynaecomastia, lifestyle changes like losing weight through diet and exercise, managing hormone levels with potential medication adjustments from a doctor, and reducing alcohol intake can sometimes help alleviate mild cases of Gynaecomastia without requiring surgery; however, for significant breast tissue buildup, surgery is often the only effective solution.

Lifestyle changes:

Lifestyle improvements may reduce mild Gynaecomastia. These include a healthy diet, regular exercise, and limiting alcohol consumption.

For those individuals where the cause of gynaecomastia is due to certain drugs and lifestyle factors – abstaining from these causes will obviously be an important part of any management plan.

Hormone therapy:

Depending on the cause, a doctor might prescribe hormone therapy to balance testosterone levels, which could help reduce breast tissue. This should only be performed under the management of a specialist endocrinologist.

Surgical plans for Male Breast Reduction

The treatment required depends on whether the breast enlargement is caused by excess fat, an increased amount of breast gland tissue, or often a combination of the two. Also, if excess skin exists, then how this is managed, and the resultant scars is a vital part of the discussion and planning. This can only be determined after a consultation with Dr Eddy Dona to determine the best surgical intervention. Scans such as a CT or an ultrasound may also be used.

Liposuction: Excess fat can be removed using liposuction alone, which is a less invasive procedure when compared to surgical excision.

Surgical Excision: When a significant amount of breast tissue and or fat needs to be removed, surgical excision is used by making a single scar along the lower areolar border. However, the surgical pattern and resulting scar will depend on the severity of the excess tissue and fat.

For those that have fully developed breasts, then some form of breast reduction procedure, and the resultant scars, will be required.