Gynecomastia and Lipomastia

What Is Gynecomastia and How Is It Different from Lipomastia?

Gynecomastia is a condition involving enlargement of glandular and fibrous breast tissue in men. It can occur at different ages and may affect one or both breasts, as well as the entire breast gland or only part of it. Gynecomastia, which involves enlargement of glandular breast tissue, should not be confused with lipomastia, also known as pseudogynecomastia, which is caused by excess fatty tissue, for example in obesity. A large proportion of cases of male breast enlargement are related to excess fatty tissue. Enlarged breasts may cause considerable embarrassment and psychological discomfort in men.

Gynecomastia – What Causes Male Breast Enlargement?

1.      In some cases, gynecomastia may be associated with elevated prolactin levels. Prolactin is a hormone produced by the pituitary gland and is responsible for milk production in women.

2.      Gynecomastia may also result from an imbalance between androgens, including testosterone, and estrogens. A relative excess of estrogen or reduced androgen activity may stimulate breast tissue growth. Estrogens are not produced exclusively in women. They are also formed in men, including through hormonal conversion in adipose tissue.

3.      Male breast enlargement may also occur in association with other medical conditions or substances, including:

·         end-stage kidney disease,

·         liver cirrhosis and liver cancer,

·         tumors, including testicular tumors,

·         thyroid disorders,

·         disorders of hepatic circulation,

·         malnutrition and cachexia,

·         vitamin deficiencies,

·         gastrointestinal diseases,

·         medications containing estrogens or increasing estrogen activity,

·         medications that reduce testosterone production or activity,

·         certain recreational drugs,

·         anabolic steroid use,

·         Klinefelter syndrome.

4.      Temporary gynecomastia may occur in newborns and infants during the first months of life due to maternal estrogens and usually does not require treatment.

5.      Physiological pubertal gynecomastia is common in adolescent boys and usually resolves without treatment.

6.      Gynecomastia may also occur in older men as part of age-related hormonal changes and does not always require treatment.

Gynecomastia Diagnosis

The most important step is to determine the cause of the breast enlargement. The first sign of gynecomastia is often a palpable lump or firm tissue behind the nipple and areola. Other symptoms may include tenderness, swelling of the nipple area or nipple discharge.

Laboratory tests may include:

• complete blood count with differential,
• liver and kidney function tests,
• serum estradiol, testosterone, TSH, LH and FSH levels,
• prolactin level,
• tumor markers when malignancy is suspected, for example beta-hCG in suspected testicular cancer,
• adrenal hormone testing when an androgen disorder is suspected.

Imaging examinations, depending on clinical indications, may include:

• breast ultrasound,
• abdominal ultrasound,
• testicular ultrasound.

In selected cases, additional investigations may include:

• thyroid ultrasound,
• magnetic resonance imaging of the brain,
• CT scan of the chest or abdomen,
• breast biopsy, particularly when glandular enlargement resembles a discrete breast tumor. It should be remembered that breast cancer can also occur in men.

Gynecomastia Treatment

The management and treatment of gynecomastia depend on its underlying cause. The treatment plan is determined individually by the doctor together with the patient.

Diagnosis and conservative treatment of gynecomastia are commonly managed by an endocrinologist.

If another underlying condition is suspected, the endocrinologist may recommend consultation with another specialist, for example a nephrologist, hepatologist, oncologist or surgeon.

Gynecomastia Surgery

Surgical treatment of gynecomastia may be considered when treatment of the underlying cause does not sufficiently reduce the breast enlargement or when no specific cause can be identified. Surgery may also be considered for lipomastia when the breast enlargement causes significant aesthetic or psychological discomfort.

Surgical treatment of gynecomastia may be performed by appropriately trained surgeons, including general surgeons, plastic surgeons and surgical oncologists.

The procedure involves removal of excess glandular and/or fatty breast tissue. Depending on the extent of the procedure, surgery may be performed under local or general anesthesia.

COMPREHENSIVE GYNECOMASTIA DIAGNOSTICS AT TARTACZNA 2 MEDICAL CENTRE IN GDAŃSK

• Breast ultrasound is performed by radiologist Dr Ewa Kołyszko.
• Endocrinology consultation is provided by Dr Anna Florysiak.
• If a breast lump has already been identified, further diagnostic assessment, including FNA (fine-needle aspiration biopsy) or core needle biopsy, is performed by surgical oncologists Dr Kamil Drucis and Dr Natalia Spychalska.

Our surgical oncologists also perform gynecomastia surgery under local anesthesia in selected patients. Prior surgical consultation and qualification for the procedure are required.

We invite you to book an appointment through our website (e-mail or telephone contact) or via ZnanyLekarz: Dr Natalia Spychalska and Dr Kamil Drucis.