Dr. Ranjit Baral Senior Cardiologist and Aviation Medical Consultant and General Physician
A 25-year-old man said that for the past few years, his chest has become like a woman’s breast. Therefore, he said that he should not change his clothes in the presence of other men. The reason for her chest size is that her ‘body is producing more sex-steroid hormones than it needs?’ Inquisitively, he asked about the way to get a normal chest.
A man’s chest resembling a woman’s breast is medically called ‘gynaecomastia’. This means that the ‘nipple’ of the male chest grows and takes the shape of the female breast.
Regardless of gender, all humans have both male hormones-androgens and female hormones-estrogens. The period of physical and hormonal changes that occur during the process of becoming an adult is called ‘puberty’ in English. It starts between 9 and 14 years of age for males.
During puberty, the amount of androgens and estrogens in the body can change and increase to various levels, so a temporary condition can be created where the relative amount of estrogens is higher than androgens.
Physiological gynecomastia is caused by an imbalance in hormone levels, where there is an increase in estrogen compared to androgen.
Breast enlargement is a normal physical phenomenon in men during infancy or puberty and if it gets better within 6 months to two years, then such a condition is called ‘physiological gynecomastia’.
Sometimes gynecomastia that starts at puberty can last for more than two years, which is called ‘persistent pubertal gynecomastia’. The same is understood to have happened to the said man. It is understood that many men in the world population are suffering from it.
Androgen hormones are essential for sexual development in both men and women. Androgen can also be taken as a supplement. Gynecomastia is seen in androgen abuse (often in athletes), marijuana abuse, alcohol abuse, the result of certain medications, malnutrition, liver cirrhosis, trauma, infection, hyperthyroidism, endocrine disorders, testicular disorders, HIV patients, tumors, kidney failure, or the elderly.
Therefore, some laboratory tests are necessary to make a definite diagnosis of gynecomastia.
Treatment
First of all, you can consult an endocrinologist. In addition to physiological pubertal gynecomastia, the cause of gynecomastia may be a symptom of testicular cancer or the ‘side effects’ of drugs used to treat other diseases. Since there are various reasons behind the occurrence of gynecomastia, it is necessary to conduct a comprehensive examination of gynecomastia patients, which should be done in a very delicate manner.
Patients are treated based on the underlying cause behind gynecomastia. For example, gynecomastia may occur due to the use of certain types of drugs, which can be relieved if ‘controlled’. Gynecomastia is usually caused by puberty, which tends to resolve on its own over time. If there is persistent gynecomastia, surgical treatment can be performed after the period of the patient’s body growth is over. Such treatment helps to increase the morale of the patient.
Other treatment options include ‘endoscopic transaxillary liposuction’ and ‘subcutaneous mastectomy’.
If gynecomastia does not resolve itself even after two years, surgery can be performed for permanent treatment, plastic surgery is suitable.
Depending on the situation, ‘periareolar male breast reduction’ may also be done, where surgery is performed around the ‘nipple areola complex’ area.
In cases with extremely large breasts (CD), ‘Classical Breast Reduction with Superior or Inferior Flaps’ can be performed. In alternative surgery, ‘vertical incision breast reduction’ can be done, by which a vertical shaped scar is left on the chest.
Other side effects of gynecomastia treatment include scarring, numbness in the treated area, and depression at the surgical site. However, gynecomastia has returned after surgery in some people.
In some painful cases of gynecomastia, aromatase inhibitors, tamoxifen and testosterone replacement in older men are also used. Currently, surgery is considered more effective than using aromatase inhibitors and tamoxifen.
Other types of gynecomastia
– Pseudo gynecomastia
– true gynecomastia (breast tissue)
– Combined pseudo gynecomastia (fatty tissue)
– Severe gynecomastia
(Senior General Physician and Cardiologist Dr. Vyodha Hospital in Baral Balkhu and Shah in BansbariEid At Gangalal National Heart Centre doing the work are.)
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