Gynecomastia

No Amount of Push-ups will reduce Gynecomastia

What causes gynecomastia (male breasts), and how can we treat it? Also, what is pseudo-gynecomastia?

One thing is for sure, “push ups” are not one of the treatments.

 

The glandular tissues in the breasts 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. Which is why females develop breasts at puberty.

Though uncommon, some boys also develop swelling in the breasts usually around puberty, but which then spontaneously resolves. It may affect one or both sided 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 “pseudo-gynecomastia”. Whereas in gynecomastia, the breast’s glandular tissues are enlarged, in psedo-gynecosmastia only the surrounding fat tissue is excessive, which then gives rise to the appearance of breasts on a man’s chest.

“Pseudo” or “real” 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” gynecosmastia is important because while pseudo-gynacomastia is mainly a body contouring issue and there are methods including 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 medical 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 commonest 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 erected 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 of course medications that can help block the oestrogen sensitivity. Drugs like Clomiphene and Tamoxifen are inexpensive ones. They may not always work. So cosmetically speaking liposuction and or surgical excision is still the surer bet.

About our Doctors

Dr David Loh is the founder of David Loh Surgery located in Wheelock Place and Novena Medical Center. He is assisted by Dr Phoon Yi Shan, who is a senior partner in the aesthetic practice. Dr David Loh is accredited by MOH to perform liposuction. Dr David Loh is the President of the Society of Aesthetic Medicine.

Our doctors use a combination of liposuction and surgical excision to help our male patients achieve a better-looking chest. We will investigate for any underlying medical condition that may be causing the hormonal imbalance.

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