The glandular tissues in the breasts (both male and female) are by nature sensitive to hormonal changes. They grow and swell when there is a surge in sex hormones. And shrink when hormone levels are low. Females develop breasts at puberty because of a surge in oestrogens.
Though uncommon, some boys also develop swelling in the breasts usually around puberty, but which then spontaneously resolves. It may affect one or both sides of their chests. The name for the condition is gynecomastia, and it is probably the result of a temporary hormonal imbalance causing the breast tissue to be sensitized. No treatment is needed for this group of boys.
A small percentage of these cases of pubertal gynecomastia continue to have a small amount of breast swelling into adulthood. In the great majority of these persistent cases, there is no underlying cause to be found. However, a small percentage of these cases are associated with a more serious underlying conditions where excessive female hormones are produced – including certain cancers. But these are extremely rare.
Quite commonly these days, gynecomastia is also associated with the abuse of anabolic steroids for body building purposes. In fact, they constitute the large majority of the cases we treat.
And then there is a condition we call pseudo-gynecomastia. Whereas in gynecomastia, the breast’s glandular tissues are enlarged, in pseudo-gynecomastia only the surrounding fat tissue is excessive, which then gives rise to the appearance of breasts on a man’s chest. There is no enlargement of any glandular tissue.
“Pseudo” or “real” forms of gynecomastia are quite easily distinguishable. When squeezed between your fingers, fat feels different from glandular tissue. Fat being softer to touch than glandular tissue. An ultrasound scan may also be useful to distinguish between the two.
Distinguishing between “pseudo” and “real” gynecomastia is important.
Pseudo-gynecomastia is mainly a body contouring issue and there are methods including Coolsculpting or liposuction which can help reduce it.
“Real” gynecomastia may be a sign of a more serious underlying pathology. And it calls for clinical investigation into whether there are underlying conditions. A series of tests (lab and X rays) should be able to rule out the more serious stuff. And the tests are not expensive. Referrals can be made if serious underlying conditions are detected.
In most of the cases, there will be nothing wrong elsewhere and then the gynecomastia becomes a purely cosmetic issue. The breast tissues can be surgically excised in a minor surgical procedure.
The most common group of patients that present with male breasts are nowadays those whom had at some point in their lives abused anabolic steroids.
The signs are very tell-tale. Firstly, these patients are bulkier in terms of muscle mass than an average male, they have rougher and more leathery skin than usual, and they have “bitched nipples” (this is body-building terminology for permanently erect nipples).
Treatment for this group of patients may involve combining a liposuction with a surgical excision, as they would have both swollen glands and accumulated fat after they abandoned the body building circuits.
There are medications that can help block the oestrogen sensitivity in gynecomastia, but they may not always work. So cosmetically speaking liposuction and or surgical excision is still the surer bet.
DR DAVID LOH
One of the Pioneers of Aesthetic Medicines in Singapore
Dr David Loh
Dr David Loh founded David Loh Surgery back in 2002 when Aesthetic Medicine as a field was still in its infancy. He obtained his basic medical and surgical degree from the National University of Singapore. He has 30 years of working experience, 18 years of which were in aesthetics. He is MOH-accredited to perform office -based Liposuction. He is perhaps best known for being a trainer for B*tox and Fillers in the region. He is the President of The Society of Aesthetic Medicine in Singapore.
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