Gynaecomastia

What is gynaecomastia?

This benign (not cancer) condition is the overgrowth of male breast tissue and is common in teenage boys and older men - although it can affect a man at any time of his life. Having gynaecomastia does not increase your chances of developing breast cancer.

Gynaecomastia can affect either one or both breasts. The symptoms can vary from a small overgrowth of breast tissue around the areola and nipple, to larger more 'female' looking breasts. The area can often be tender to the touch and sometimes painful, but this isn't the case for everyone.

True gynaecomastia, which is caused by the overgrowth of breast tissue, is different from pseudo-gynaecomastia, which consists of fatty tissue. However, gynaecomastia can also be a mixture of both.

What causes it?

Puberty

Boys usually reach puberty in their teenage years. However, some may notice changes when they're as young as 10. When puberty starts there is a rise in the levels of the hormones oestrogen and testosterone.

At this time boys have varying levels of testosterone. If these levels are very low, the higher level of oestrogen circulating will affect the breast tissue. As a result, small branching tubes (ducts) in the breast grow, meaning the the breast or breasts become much larger and more noticeable.

By around the age of 15, testosterone levels start to settle at a constant high level. This stops the oestrogen from having any further effect on the breast tissue. By the age of 19, the breast or breasts have usually begun to shrink down and flatten out. It has been reported that two out of three teenagers develop a degree of gynaecomastia with 90 per cent of cases resolving by themselves.

Ageing

As a person grows older they tend to have more body fat, which produces more oestrogen. As men get older they also produce less testosterone. So the combination of an increase in oestrogen levels and reduced testosterone levels can once again have an effect on breast tissue, causing the breasts to become larger.

Many men see this change as a part of the ageing process. However, if you're particularly concerned, speak to your GP who may refer you to a breast clinic.

Other causes

Other causes of gynaecomastia can include ill health, drugs (both prescription and recreational), diet and the overuse of alcohol. In most cases, gynaecomastia will not be the only symptom or side affect and it is often not possible to pinpoint a specific cause as to why a man develops the condition.

Diagnosis

Your GP may be able to identify gynaecomastia but they may also refer you to a specialist breast clinic for tests and a definitive diagnosis.

At the breast clinic, you may have a breast examination, a mammogram and/or ultrasound scan. If these tests prove inconclusive, this could also be followed by a fine needle aspiration (FNA) and/or core biopsy. See our Referral to a breast clinic publication for more information on these procedures.

Because gynaecomastia can be a symptom of other conditions, such as hyperthyroid (overactive thyroid gland), your specialist may also want to examine your testicles, neck and abdomen. They may also ask you to have further tests, for example a blood test.

Treatment

In most cases, treatment or follow up will not be necessary. However, it is important to be vigilant and to go back to your GP if your breast/s becomes larger or more painful, or if you have any new symptoms.

For some people, just removing the cause of the gynaecomastia (such as changing medication or reducing alcohol intake) is all that's needed to reduce the extra breast tissue. Other people may need to have medical treatment and/or surgery.

Medical treatments

Occasionally your specialist may say you need to be treated with hormonal drugs. The drugs used to treat gynaecomastia are danazol, tamoxifen and clomiphene. Although these hormonal treatments are not licensed for treating gynaecomastia, they have been shown to be useful in some cases. Your specialist will want to follow you up regularly while you are on these drugs.

There are no guidelines on which treatment should be considered first. While you’re taking these drugs you may experience side effects so they’re only suitable for use following a thorough discussion of their benefits and risks.

Surgery

Generally surgery is not recommended as a treatment for gynaecomastia. However, if you’ve had gynaecomastia for a long time and/or it hasn’t improved with other treatments, your specialist may discuss an operation to reduce the amount of breast tissue you have.

The aim of the different surgical techniques is to restore your chest to a more normal size. The type of operation will depend on the size of the gynaecomastia.

What it means

Gynaecomastia can be a distressing or embarrassing experience for many, despite it being a common condition. In particular, boys going through puberty may find it embarrassing or difficult to discuss growing and/or painful breasts.

Gynaecomastia is a benign condition and does not increase your chances of breast cancer, although it is still important to be breast aware and visit your GP if you notice any changes in your breasts.