Gynecomastia

How Common Is Gynecomastia?

Gynecomastia is a relatively common condition in men. Surgical removal of gynecomastia is the fifth most common aesthetic procedure performed on men. The condition can occur at any stage of life:

• In younger men: hormonal imbalance during development
• In older men: higher likelihood of more serious, organic causes

Despite high rates of spontaneous resolution, an experienced doctor should always be consulted for a precise diagnosis by way of blood testing (to establish a hormonal imbalance between testosterone and oestrogen), ultrasound, and, where appropriate, mammography. If findings are abnormal, a so-called needle biopsy for tissue examination may be necessary.^[1]

How Is Gynecomastia Diagnosed?

Because there is still disagreement in the scientific literature about how frequently the various causes occur, a thorough examination by an experienced doctor is especially important so that serious conditions are not overlooked.^[2]

Diagnosis typically includes:

• Physical examination
• Blood test (hormone levels)
• Ultrasound (sonography)
• In the case of abnormal findings: mammography or needle biopsy (tissue sample under local anaesthesia)^[3]

This precise diagnostic work-up is important to rule out other conditions that can present similarly, such as cysts or infections.^[4]

What Medications Can Cause Gynecomastia?

Certain medications can trigger gynecomastia as a side effect:

• Antiandrogens
• Psychotropic drugs

Conditions such as liver cirrhosis (significant damage to the liver) can also cause gynecomastia.

Why Is Gynecomastia Increasing in Modern Times?

A substantial rise in the rate of gynecomastia over the past 20 years is notable. Possible causes rooted in modern civilisation include:

• Hormonally active substances in cosmetics that enter our wastewater and environment
• Hormonally active plasticisers in plastic bottles
• Environmental pollution

In parallel, prostate cancer and type 2 diabetes have also risen significantly. A complex of causes rooted in modern civilisation appears to be involved.^[5]Analysing and changing lifestyle habits can be helpful here.

Can Anabolic Steroids Cause Gynecomastia?

Yes, the growing use of anabolic steroids has by now become a significant cause of gynecomastia. This also affects amateur athletes and gym-goers. The muscle-building effect of anabolic steroids is based on hormonal action, which carries risks and side effects.^[6]

An experienced doctor will ask patients in detail about their circumstances. Patients should be completely honest with their doctor for successful treatment.

Anabolic steroids should generally be avoided, as they carry numerous side effects – not only gynecomastia. Their use also increases the burden of hormonally active substances in wastewater.

What Are the Symptoms of Gynecomastia?

Typical symptoms of gynecomastia include:

• A palpable, usually tender hardening beneath the nipple
• Visible enlargement of one or both breasts
• A feeling of tightness or pressure in the chest area
• In rare cases, pain or tenderness of the nipples

The changes can occur on one or both sides. Many affected men find the change highly distressing, which can lead to considerable psychological strain – particularly in situations such as sport, the sauna, or sexual activity. And, with that, to a marked reduction in quality of life.

How Is Gynecomastia Treated?

When Is No Treatment Necessary?

If the condition does not cause the patient excessive psychological and social distress, treatment is often unnecessary, especially in younger patients. Gynecomastia frequently resolves on its own within about two years, once the hormonal imbalance normalises or the patient stops using anabolic steroids.^[7][8]

What Medical Treatment Options Are Available?

If the patient does not want to wait out these two years and no serious underlying cause is present, drug therapy over six months may be attempted for mild to moderate cases. Selective oestrogen receptor modulators (SERMs) are used, which block the effect of oestrogens and show good results.^[9][10]

Important: Because every medication carries side effects, they should only be used under the continuous supervision of an experienced doctor.

When Does a Gynecomastia Operation Make Sense?

An operation is advisable when:

• the gynecomastia has persisted for more than 12–24 months,
• pain or significant psychological distress is present,
• the breast does not regress through medical treatment.

How Does a Gynecomastia Operation Proceed?

The procedure is performed by us, as doctors and a team highly experienced in this field, usually on an outpatient basis under general anaesthesia:

• Recovery time: a few days
• Physical rest: 2–3 weeks recommended
• Results: usually permanent and aesthetically very satisfying

The condition of gynecomastia is often highly distressing psychologically for affected patients, disrupts social life, and reduces quality of life. These factors can be markedly improved again through an operation to correct the gynecomastia.^[11][12]

A successful gynecomastia operation carried out by a professional team such as ours therefore has a considerable positive effect on the quality of life and the psychological wellbeing of the man affected.

Does Quality of Life Improve Through the Operation?

The burden and disruption to quality of life caused by this condition are so significant that the great majority of patients are very satisfied with the results of the operation and the improvement in quality of life – regardless of the severity of the condition, the technique used, and the extent of the operation, and even regardless of complications that depend on the severity of the condition.^[12]

This high level of satisfaction can only be achieved by doctors experienced in this operation.

What Surgical Techniques Are Available for Gynecomastia?

The process varies from patient to patient. Duration of surgery, severity, and time off work cannot be described in general terms. A medical consultation plus examination by our experienced team is essential.

Gynecomastia should only be treated by doctors with extensive experience in this field and a demonstrable track record of successful outcomes.

Modern Surgical Techniques

Depending on severity, surgically correcting gynecomastia can be complex, as not only fatty tissue and glandular tissue but also skin and nipples can be affected by the condition. It is particularly important to operate in a way that is extremely tissue-sparing and avoids creating numerous or large scars.^[12]

Our modern surgical techniques and our knowledge of which technique should be used for which patient offer considerable advantages here.

Gentle Surgical Technique

In some patients, alongside the classic method, a surgical technique based on the latest findings is also used – namely liposuction performed through the armpit, combined with a small, inconspicuous incision around the nipple. This technique significantly reduces operating time and the risk of complications.^[14]

Precise Findings and Surgical Planning Are Important for Success

Where sensible and necessary, an experienced team such as ours can also use liposuction with vibrating cannulas and ultrasound. This can offer decisive advantages.^[15][16]

Our experienced team may even additionally use a tumescent technique – a particularly gentle form of anaesthesia for liposuction that further reduces the risk of such an operation.^[17]

Where Can I Get More Information About Gynecomastia Treatment?

If you are interested in this treatment, please feel free to contact our office staff with confidence. We are also happy to provide a second opinion.