Gynecomastia. Causes of gynecomastia in men, symptoms and treatment Is gynecomastia in men a serious disease?

True gynecomastia is an increase in the glandular tissue of the mammary glands. It is typical for men, but also occurs in women. The chest increases in size up to 10 cm and acquires a semblance of roundness.

ICD 10 code is No. 62.

Often men are embarrassed to go to the hospital and end up in a state where they already need treatment.

Gynecomastia occurs in newborns, adolescents or older men.

If the mother's sex hormones enter the baby's body through milk, he or she develops temporary gynecomastia. No treatment is provided. Symptoms disappear without a trace after 3-4 weeks.

During the period of hormonal changes, teenage boys experience the influence female hormones. The disease appears between the ages of 14 and 17. Without treatment, gynecomastia does not go away on its own and progresses, but not always.

In adolescents, bilateral gynecomastia is noted with swelling of the areola, breasts and hypersensitivity nipples

In older men, on the contrary, the effect of testosterone subsides. Its deficiency in the body provokes active work estrogen and increase mammary glands. More common in obese men.

Peculiarities

There are two types of gynecomastia in men: false and true. Visually, upon examination or from a photo, they are barely distinguishable: nipples and halos begin to blur, hair on the chest falls out, and a round shape appears. The false type is characteristic of obesity, and all changes are associated with the deposition of fat around the breast; it does not require treatment.

The true type is characterized by an increase in the glandular tissue of the breast in men. It can be distinguished by palpation of the nipples, around which in the initial stages a small compaction can be felt. Both types can be combined, but only false gynecomastia gives outwardly expressive breasts.

Causes

Male gynecomastia is always caused by impaired hormonal metabolism. It can be triggered due to the following reasons:

hormonal changes during adolescence and old age
disruption of testosterone production caused by testicular tumors, gastrointestinal problems, lung or pancreatic cancer
inflammation of the testicles or prostate adenoma
an increase in the amount of the hormone prolactin with abnormalities in the functioning of the pituitary gland
metabolic diseases: diabetes, obesity
for cirrhosis of the liver, intoxication of the body, kidney problems
prolonged fasting
frequent chest injuries, burns, blows, reaction to surgery
uncontrolled treatment with drugs that affect the endocrine system
drugs and alcohol - inhibit liver function and, as a result, disrupt metabolism steroid hormones(this especially applies to opiates), drugs also stimulate the secretion of prolactin
genetic predisposition and increased sensitivity of the body to estrogens in men
psychological trauma, cranial nerve damage, epilepsy and other mental disorders

Symptoms and manifestations

Clinical manifestations depend on how early the man came for examination. First, the skin around the nipple becomes rougher, then the breast increases in size, and sometimes there is discharge from the nipples.

What else is characteristic of gynecomastia in men:

pigmentation and swelling, halos
nipple sensitivity
Tight clothes cause discomfort
bloody issues from the nipples
compaction in the form of a “pea” or “bean”

Diagnostics

Methods for diagnosing gynecomastia are extremely simple - examination and ultrasound, and blood tests. The examination should be carried out at the first symptoms: lump in the chest and general deterioration condition.

Self-examination

It is impossible for a man himself to visually determine whether he has gynecomastia or not. Pathology requires tests and instrumental examination. The maximum that can be detected is a lump in the breast and atypical sensitivity of the nipples.

Examination by a doctor

At the first appointment, the doctor collects the most detailed history of the man’s life and finds out the diseases of the patient’s immediate family, lifestyle and bad habits. A thorough examination of the breast is carried out: the lump is palpated, the location is determined, mobility and adhesion to adjacent tissues are determined, the number of lumps and their size are determined, the presence of fluid discharge from the nipples is determined, the enlargement is checked axillary lymph nodes.

The presence of symptoms of feminization in a man is determined: a change in the timbre of the voice, a change in the thickness of the hairline, they examine the genitals, and determine the size of the penis and testicles.

If a pathology is suspected, the man is sent for an ultrasound, where the type of gynecomastia is determined, the nearby tissues and the structure of the glands are examined.

Other types of diagnostics

Biopsy and mammography can clarify the diagnosis. Both studies are prescribed to differentiate the diagnosis and establish the form of the disease. A biopsy involves removing a piece of tissue or cells to be examined.

In addition, blood tests are prescribed for the hormones prolactin and testosterone. If the level of the latter is elevated, ultrasound diagnostics of the testicles is performed and computed tomography adrenal glands This allows you to track organic changes in structures.

Treatment

Treatment of true gynecomastia in men involves conservative and surgical intervention.. Therapy depends on age:

If we are talking about a newborn child, then treatment is not provided. The pathology goes away on its own after a month. But in the absence of positive dynamics, a consultation with a pediatrician is required.
Gynecomastia in adolescents and older men requires restoration of hormonal levels: a decrease in estrogen production against the background of an increase in testosterone. The drugs Testolactone, Clomiphene, Tamoxifen, and Danazol are prescribed.

Main methods of treatment:

refusal of treatment with drugs that caused pathology
not using drugs or alcohol
training the pectoral muscles to strengthen them
normalization of hormonal levels
increasing testosterone levels
breast contouring – when changing the natural shape
medicinal electrophoresis with iodine, mud and laser treatment

Treatment with medications is justified only in the first stages of gynecomastia. Facilities traditional medicine to no avail. If there is no positive response to conservative therapy, surgery is prescribed to stop breast growth and remove the cosmetic defect.

Treatment for adolescents is based on taking injectable vitamins B1 and AEvit. In cases of severe pubertal gynecomastia, treatment with bromocriptine and its analogues and the use of prolactin inhibitors are common. With the hypopubertal variant, the level of testosterone in the blood is increased with the help of steroid drugs.

When treating older people, it is important to choose a wait-and-see approach, which includes an active differential diagnostic search for the cause of gynecomastia.

Types of operations

There are three types of surgical treatment for gynecomastia:

traditional mastectomy – removal of the nipple-areolar complex.
subcutaneous – preservation of the nipple and areola
endoscopic – removal of compaction, used for small glands

For drooping nipples in men, an incision is made from above, removing the swelling and tightening the skin to its natural state. Mastectomy is performed under general or local anesthesia. IN rehabilitation period It is mandatory to wear a bandage to avoid breast deformation.

Rehabilitation

During the two-week period of healing of the sutures, men experience pain and discomfort. To relieve them, painkillers and restorative drugs are prescribed.

In the first three days, bed rest is strictly observed without lifting weights, other physical activity so as not to damage the integrity of the seams.

wear the bandage for three weeks, do not remove it at night
follow a diet that is gentle on the gastrointestinal tract to avoid constipation and other digestive disorders
when complications occur: fever, suppuration of sutures, severe pain, general weakness, seek urgent medical help

Prognosis for treatment of gynecomastia in men

Infantile gynecomastia has the most favorable outcome and does not need treatment. Since the appearance of the disease is caused by pathology not in the baby’s body, but by a temporary phenomenon. In teenage boys, symptoms disappear with treatment during puberty: in 75% over the next two years, in the remaining 15% after three years.

Treatment of gynecomastia caused by destructive processes in men is as favorable as it is possible to eliminate the cause that led to the change in the glands. At dosage form the treatment is favorable, since the doctor simply changes the drug to a safer one. For gynecomastia caused by organ pathologies, the prognosis depends on the treatment of the underlying cause.

Army and disease

The presence of this disease is not valid medical reason in order not to serve in the army. The only exceptions are those young men whose illness is caused by serious pathologies in the functioning of the endocrine, digestive or cardiac systems.

Young men who undergo postoperative rehabilitation and have positive recovery dynamics are suitable for military service after full recovery.

Prevention of gynecomastia

Gynecomastia is dangerous because it can suddenly progress without the appearance of clear symptoms. The man feels neither discomfort nor external changes. But the long course of the disease provokes the occurrence of breast cancer and enlargement of the axillary lymph nodes.

Proper prevention helps men avoid pathology and terrible complications:

health care and examination by a mammary gland doctor
healthy image life, which includes giving up bad habits, organization rational nutrition, the ability to competently relax and shoot nervous tension, for example, drinking chamomile, thyme, yarrow, mint or lemon balm teas at night
Treatment with medications that can disrupt hormonal levels should be supervised by a doctor
treatment of urological diseases and sexually transmitted infections in men
if there are any suspicious signs, exclude self-treatment

Due to an imbalance in the hormonal balance in the body, hypertrophy of adipose tissue can occur in men, which leads to an enlargement of the mammary glands - rudimentary organs consisting of short ducts and the nipple.

The functioning of these organs occurs in the presence of estrogens and prolactin. IN male body the number of estrogens is extremely small, because these are female hormones, any excess of them is immediately eliminated by the liver. However, if for some reason the number of estrogen exceeds the norm, male mammary glands begin to grow like women's, which leads to the appearance of gynecomastia in men.

But excess estrogen is not the only cause of this condition. If prolactin is produced by the pituitary gland in excessive quantities, adipose tissue is deposited in the mammary glands and connective tissue quickly grows. As a result, the mammary glands become denser and enlarged.

So, the causes of gynecomastia in men are:

a violation of the ratio of testosterone and estrogen in the body, which occurs due to malfunctions of the gonads, tumors of the testicles, adrenal glands, and stomach;
increased production of prolactin due to a pituitary tumor;
diseases associated with metabolic disorders, such as diabetes;
taking medications that provoke an increase in the production of estrogen and prolactin.

Signs of pathology

An increase in the diameter of the mammary glands is the main symptom of gynecomastia in men. At the same time, the nipples and surrounding areolas enlarge. Can be seen, although this is rare. There may be a feeling of discomfort in the mammary glands and increased sensitivity of the nipples. If, simultaneously with the listed symptoms, lumps appear in the mammary glands, bloody discharge is observed, and the lymph nodes in the breast become enlarged. armpits, you should visit a doctor immediately. After all, such signs may indicate not only gynecomastia in men, but also breast cancer.

Diagnostics

To accurately determine the presence of pathology, external examination not enough. Blood tests are carried out to determine the amount of prolactin, testosterone, urea, creatinine and other substances and hormones in it. In addition, CT, ultrasound and other studies can be performed.

Gynecomastia in men: treatment

The treatment method is selected depending on the reasons pathological process. So, if gynecomastia is caused by taking medications, they are simply discontinued, and the condition returns to normal on its own. If hormonal changes are associated with an increase in estrogen, medications that lower their level are prescribed. In cases where medications alone cannot get rid of the problem, it may be recommended for men. The price of such a procedure varies in different clinics, and the operation itself consists of eliminating excess tissue and fat deposits in the mammary gland area.

The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Gynecomastia is an enlargement of the mammary gland in men due to the proliferation of glandular or adipose tissue, caused by hormonal imbalances in organism. Gynecomastia is manifested by an increase in the size and thickening of the breasts, an unpleasant feeling heaviness and pain when palpated. In some cases, breast enlargement is physiological and can go away on its own, without any treatment. In other cases, conservative therapy is carried out. If conservative treatment is ineffective or the person is not satisfied with the aesthetics of his own body, they carry out surgery, during which tissue is removed mammary gland fully.

Brief characteristics of gynecomastia

The name of the disease "gynecomastia" is derived from two Latin words– gynes (woman) and mastos (breasts). That is, the literal translation of the term “gynecomastia” is female breasts, which fully corresponds to the main thing external manifestation essence of the disease. After all, gynecomastia is a benign increase in the size of the mammary glands in men. To put it simply, representatives of the stronger sex grow female breasts.

Breast enlargement can occur due to the proliferation of ducts and glandular tissue or due to fat deposits. If the breasts increase due to the growth of glandular tissue, then gynecomastia is considered true, and the increase in breast volume due to fat deposits is false gynecomastia.

The severity of breast enlargement can vary - from 1 to 10 cm, and involve one or both mammary glands. More often, symmetrical damage to both mammary glands occurs simultaneously; enlargement of only one breast with gynecomastia is quite rare. Enlarged mammary glands with gynecomastia usually look slightly droopy female breasts Not big size.

The development of gynecomastia of any type is based on an imbalance of sex hormones with a predominance of estrogens. That is, any diseases, medications, drugs and other items that can lead to more estrogen in a man’s body than testosterone can cause gynecomastia.

The fact is that the predominance of estrogens leads to the fact that they begin to affect tissues that are sensitive to them, which include the ducts of the mammary glands. Under the influence of estrogens, breast tissue, which in men is in its infancy, begins to actively grow, forming breasts. That is, there is a process similar to what happens in the body of young girls during puberty, when their breasts begin to grow, the pelvic bones increase, etc.

Normally, breast formation does not occur, since the estrogens present in the male body do not have an activating effect on breast tissue for two main reasons. Firstly, there are very few estrogens, so their effect on the glandular tissue of the breast is not able to remove the latter from the embryonic state in which it is located. Secondly, estrogens are suppressed by a large amount of testosterone, which is produced in the male body and determines characteristic sexual characteristics. But if for some reason the amount of estrogens increases and they begin to prevail over testosterone, then the growth of tissues that are normally in the male body in their infancy is activated. As a result, the feminization of the man occurs, that is, female sexual characteristics appear, which include breasts.

Thus, gynecomastia develops if estrogen predominates over testosterone in a man’s body. Moreover, the cause of hormonal imbalance is not important, since gynecomastia is triggered precisely by an increase in the content of estrogen relative to testosterone.

During the course of gynecomastia, three successive stages are distinguished, such as proliferating, intermediate And fibrous. At the proliferation stage, the process of proliferation of the ducts and glandular tissue of the mammary gland occurs, which lasts an average of 4 months. Next, in the intermediate stage, which lasts 4–12 months, the mammary gland matures. During the fibrotic stage, dense connective tissue appears in the mammary gland and body fat, which completes the complete formation of the organ. Accordingly, during the first 4 months a person notices that his breasts are growing, and then they notice their tightening.

Treatment of gynecomastia can be conservative or surgical. In all cases, first resort to conservative therapy, which allows you to stop the progression of the process and in many situations achieve complete “resorption” of an already formed breast. Surgical treatment of gynecomastia is carried out only if there is a tumor formation in the mammary gland or the man is not satisfied with appearance chest for aesthetic reasons. If there is a tumor in the mammary gland, surgery for gynecomastia is mandatory. But operations to remove breasts for aesthetic reasons are not always performed, since in many cases the appearance of the chest after surgery may be even worse than before it.

Conservative treatment, begun in the proliferating stage, allows for complete involution and disappearance of the breast, since all changes are still reversible. Conservative treatment started at an intermediate stage can only stop the progression of the process, but reverse involution and disappearance of already grown breasts can be achieved only in rare cases. Conservative treatment at the fibrotic stage also only allows you to stop the progression of the process, but with its help it is impossible to achieve the disappearance of the breast under any circumstances. This means that in order to eliminate formed breasts, you will have to resort to surgery, during which glandular and fatty tissue is removed.

Gynecomastia – photo

This photograph shows a young man with gynecomastia before surgery (left) and after breast removal (right).

This photograph shows a man with severe gynecomastia.

Classification and characteristics of types of disease

Currently, depending on the character causative factor and the type of tissue that forms the enlarged mammary gland, gynecomastia is divided into four main types:
1. Physiological gynecomastia;
2. True gynecomastia;
3. False gynecomastia;
4. Idiopathic gynecomastia.

Some scientists and doctors distinguish only two main types of gynecomastia - true and false, and physiological and idiopathic are classified as variants of true. However, in world practice, the above version of the classification is used. We believe that these differences between classifications are not fundamental, since regardless of whether idiopathic and physiological gynecomastia are included in the true gynecomastia or are separated into separate varieties, their essence and characteristics are unchanged. To avoid classification confusion, we will consider the characteristics of all types of gynecomastia in separate subsections with appropriate names.

Physiological gynecomastia

Physiological gynecomastia is a variant of the age-related norm in which the glandular tissue and ducts of the mammary glands grow. It is not a sign of any disease, goes away on its own, and therefore does not require special treatment. Physiological gynecomastia occurs in males during age periods in which hormonal changes occur.

Thus, the following variants of physiological gynecomastia are distinguished, occurring at different age periods in males:

Gynecomastia of newborns;
Adolescent gynecomastia (pubertal);
Senile gynecomastia.

Gynecomastia of newborns appears in infant boys in the first days of life and goes away on its own within 2 to 4 weeks. Typically, gynecomastia is observed in 60–80% of newborn boys and is caused by exposure to maternal estrogens that penetrate through the placenta. When all the estrogens that enter the baby’s blood from the mother’s body during pregnancy are utilized, the gynecomastia will go away, and the mammary glands will involute, turning into completely flat formations with protruding small nipples.

Adolescent gynecomastia also called pubertal because it occurs at the age of puberty in which it occurs puberty child and there is a dramatic hormonal change. In boys aged 12–15 years, gynecomastia is observed in 30–60% of cases, and, as a rule, both mammary glands become enlarged. But in rare cases, gynecomastia affects only one breast. The resulting asymmetry is very noticeable. Sometimes a whitish fluid is released from the nipples of enlarged breasts.

This type of gynecomastia is a variant of the age norm, goes away on its own within 1 to 2 years and does not require treatment. However, if after 2 years the gynecomastia has not gone away, then it is called persistent, is considered pathological and, accordingly, requires treatment.

Unfortunately, the exact causes of teenage gynecomastia have not yet been established. However, it is known that in the early stages of puberty in boys, estrogens are produced in greater quantities compared to testosterone, which is the triggering factor for the development of temporary gynecomastia. As long as estrogens prevail over androgens in a young man’s body, he will have gynecomastia. But when the balance of hormones returns to normal, involution will occur and the grown breasts will collapse.

In principle, teenage gynecomastia is not a pathology, but it can cause serious psychological and sexual disorders in a teenager who experiences fear due to the “wrong” appearance. Therefore, a boy suffering from gynecomastia needs psychological help and moral support for the entire period until his body returns to its normal state. However, parents should remember that if a boy has no other signs of puberty due to gynecomastia (growth of hair on the body, armpits, pubic hair, change in voice, etc.), then breast enlargement is a symptom of severe endocrine diseases, such as hormone-producing tumors of various locations.

Senile gynecomastia develops in men aged 55–80 years due to a decrease in testosterone production. Due to a decrease in testosterone levels, estrogens begin to prevail, as a result of which gynecomastia develops. As a rule, both breasts become enlarged. Involution of senile gynecomastia occurs rarely, but this condition is a normal variant, so it is almost never treated.

False gynecomastia

False gynecomastia is also called pseudogynecomastia or adiposomastia. At false gynecomastia enlargement of the mammary glands occurs due to the deposition of fat under the skin in the area of the areola of the nipple. The difference between false gynecomastia and all its other types (true, physiological and idiopathic) is the enlargement of the mammary glands due to fat deposition. And with other types of gynecomastia, the enlargement of the mammary glands occurs due to the proliferation of glandular tissue and ducts.

As a rule, false gynecomastia develops against the background of general obesity and can be significantly expressed.

True gynecomastia

True gynecomastia is an enlargement of the mammary glands due to the proliferation of glandular tissue and ducts; it is a pathology and requires treatment. True gynecomastia develops when estrogen prevails over androgens in a man’s body. However, hormonal imbalance is only a triggering factor and ensures necessary conditions for the proliferation of glandular tissue and breast growth. Accordingly, the causes of gynecomastia are factors that cause hormonal imbalance. And the reasons causing disturbance hormonal balance with a predominance of estrogen levels over androgens are very diverse, and therefore the range of factors that can lead to true gynecomastia is wide.

It has now been established that The causes of true gynecomastia may be the following factors:

Output large quantity estrogens hormonally active tumors testicle, liver or lung (for example, germinoma, leydigoma, etc.);
Insufficient utilization of estrogen in the liver in severe diseases of this organ (for example, cirrhosis, chronic hepatitis, etc.);
Reception medicines that increase estrogen levels and suppress testosterone production (for example, anabolic steroids, glucocorticosteroids, estrogen preparations, cardiac glycosides, drugs, ACE inhibitors, calcium channel blockers, Spironolactone, Furosemide, Diazepam, Reserpine, Theophylline, Methyldopa, etc.);
Hyperthyroidism ( increased level thyroid hormones in the blood) or hypothyroidism (low levels of thyroid hormones thyroid gland in blood);
Androgen deficiency caused by underdevelopment of the genital organs with genetic diseases(Klinefelter syndrome, Reifenstein syndrome, etc.);
Testicular feminization syndrome;
Hermaphroditism;
Prostatitis;
Diseases of the adrenal glands;
Obesity;
Acromegaly;
Hypogonadism;
Testicular dysfunction due to trauma, orchitis, infectious diseases or exposure to ionizing radiation;
Castration;
Brain damage (consequences of traumatic brain injury, Parkinson's disease, syringomyelia, epilepsy, meningoencephalitis, Friedreich's disease, pituitary tumors, etc.);
Continuous use of plasmapheresis against the background of chronic renal failure.

Idiopathic gynecomastia

Idiopathic gynecomastia is a variant of true gynecomastia, in which it is not possible to determine the cause of the disease.

Gynecomastia in women

Strictly speaking, gynecomastia does not exist in women, since this term refers exclusively to breast growth in men. But in everyday life, the phrase “gynecomastia in women” usually means enlargement of the mammary glands at different periods of life. The fact is that the growth of breasts in girls at the stage of puberty does not frighten anyone, but the enlargement of the mammary glands in other periods of life causes concern and is called “gynecomastia”.

However, calling breast growth in women gynecomastia is incorrect. After all, during women’s lives, fat is deposited in the mammary glands, connective tissue grows, and the number of glands increases during pregnancy, which can lead to natural breast enlargement. These are the completely normal and physiological processes unreasonably and incorrectly called "gynecomastia". But women should remember that they do not have gynecomastia.

Representatives of the fair sex have completely different diseases of the mammary glands, which in no way correlate with breast growth, so you should not be afraid of simply enlarged breasts, which are not combined with any other symptoms of trouble in the body. And too large breast size in women is not called gynecomastia, but hypertrophy.

Gynecomastia - causes

So, the causes of true and idiopathic gynecomastia may be the following factors:

1. Tumors localized in the testicles, liver, lungs.

2. Breast tumors.

3. Severe liver diseases (liver cirrhosis, chronic hepatitis).

4. Chronic renal failure with regular hemodialysis.

10. Congenital dysfunction of the adrenal cortex.

11. Dystrophy due to starvation or obesity.

12. Exposure to radiation.

13. Disorders of the hypothalamus (dysregulation of the adenohypophysis, etc.).

14. Diseases in which the function of the pituitary gland is impaired:

Hypogonadism;
Acromegaly;
Itsenko-Cushing syndrome;
Pituitary tumors (adenoma, prolactinoma, etc.);
Increased intracranial pressure.

15. Disruption of the brain structures that regulate the production of hormones:

After a traumatic brain injury;
Against the background of parkinsonism;
Against the background of epilepsy;
Against the background of syringomyelia;
After meningoencephalitis;
Against the background of Friedreich's disease.

16. HIV infection.

17. Leprosy.

18. Abrupt cessation of sports activities against the background of previous intense training.

19. Active nutrition after a long period of abstinence from eating.

20. Chest injury.

21. Herpes zoster rash in the chest area.

22. Abuse of alcohol and drugs, especially opium, methadone, heroin and marijuana.

In addition, gynecomastia can be provoked by taking the following medications:

Estrogens (Estrace, Gynodiol, Alora, Esklim, Senestin, Premarin, Estratab, combined oral contraceptives);
Antiandrogens (Buserelin, Flutamide, Finasteride, Androcur, etc.);
Gonadotropin preparations (for example, human chorionic gonadotropin, etc.);
Testosterone preparations with long-term use (Testosterone propionate, etc.);
Anabolic steroids (Methandrostenolone, Phenobolin, etc.);
Glucocorticosteroids (Prednisolone, Dexamethasone, etc.);
Spironolactone (Veroshpiron, Aldactone, Uractone, etc.);
ACE inhibitors (Enalapril, Perindopril, Lisinopril, Captopril, etc.);
Calcium channel antagonists (Nifedipine, Verapamil, Amlodipine, etc.);
Cardiac glycosides (Digoxin, Korglykon, Strophanthin, etc.);
Anti-tuberculosis drugs (isoniazid);
Tricyclic antidepressants (Imipramine, Amitriptyline, Doxepin, etc.);
Benzodiazepines (Phenazepam, Diazepam, etc.);
Proton pump inhibitors (Omeprazole, Ranitidine, Cimetidine);
Antitumor drugs (Vincristine, Myelosan, etc.);
Tranquilizers (Hydroxyzine, Benactizine, Buspirone, Meprobamate, etc.);
Neuroleptics (Risperidone, Sulpiride, Tiapride, Azaleptin, etc.);
MAO inhibitors (Iproniazid, Nialamid, Phenelzine, Eprobemid, Moclobemide, etc.);
Drugs for the treatment of HIV (Amprenavir, Empricitabine, etc.);
Amiodarone;
Busulfan;
Methyldopa;
Penicillamine;
Rauwolfia;
Reserpine;
Theophylline;
Phenytoin;
Phenothiazine;
Ethionamide.

Gynecomastia caused by taking medications is not pathological and goes away on its own after stopping the use of the drug that provoked the growth of mammary glands in men.

Gynecomastia - signs

The main symptom of gynecomastia is an enlargement of the mammary glands so that they look like small female breasts. With gynecomastia, the mammary glands can increase from 2 to 15 cm in diameter. At the same time, according to the size of the mammary glands, the diameter of the nipple areola increases, expanding to 3–4 cm. The pigmentation of the areola intensifies.

When palpated, the mammary glands may be dense, with nodular formations inside. You may also feel slight pain when you feel your breasts. The overgrown breast tissue is tightly fixed to the pectoral muscles and skin, so attempts to move the seal in any direction or pull the skin over them are useless. In rare cases, fluid similar to colostrum is released from the nipples with gynecomastia. Also, sometimes men feel a feeling of pressure in the mammary glands and discomfort when clothing rubs against the nipples.

IN clinical course Gynecomastia has three successive stages:

Stage I (proliferation) – lasts about 4 months and is characterized by a progressive increase in the size of the mammary glands. At this stage, all changes are reversible, and if you start conservative treatment, you can achieve complete “resorption” of the grown breast in all cases.
Stage II (intermediate) – lasts 4–12 months and is characterized by the maturation of grown breast tissue. At this stage, the changes are difficult to reverse, so conservative treatment rarely achieves involution of an already grown breast.
Stage III (fibrous) – lasts for a long time and is characterized by the growth of connective tissue and fatty deposits in the mammary gland. At this stage, the changes are irreversible, and conservative treatment can only stop the progression of the disease, but it is impossible to achieve involution of the grown mammary glands with its help.

The signs of gynecomastia are the same at stages 2 and 3, but at the first they differ in that the mammary glands progressively increase in size.

Depending on the size of the mammary gland, gynecomastia is divided into weak, moderate And expressed. To determine the size of gynecomastia, the circumference of the breast and its height are measured, after which the index is calculated. If this index is less than 6, then gynecomastia is weak, index 6 – 10 means moderate gynecomastia, and index more than 10 means severe.

Gynecomastia: causes (cancer, cirrhosis of the liver, obesity), diagnosis (pregnancy test, ultrasound) - video

Treatment

General principles of therapy

Physiological gynecomastia is not treated, because it goes away on its own after the hormonal balance in the body is normalized. Fatty gynecomastia does not require treatment, since it is completely safe, and therefore its therapy is carried out only at the insistence of the patient who wants to eliminate enlarged mammary glands for aesthetic reasons. In this case, liposuction surgery is performed, during which the fatty tissue is removed and the breasts acquire normal shape.

For the treatment of pathological and idiopathic gynecomastia, conservative and surgical methods. Conservative treatment should be comprehensive and aimed simultaneously at eliminating the underlying disease that provoked gynecomastia and at relieving the effects of estrogen. Often, when the underlying disease cannot be treated (for example, taking medications, etc.), gynecomastia is treated with drugs that suppress the effects of estrogen. Surgical treatment is resorted to only if conservative therapy has proven ineffective within 2 years of its implementation, and the person insists on complete removal enlarged mammary glands for cosmetic reasons.

If gynecomastia is caused by a tumor formation in the mammary gland, then the only method of treatment used is surgery to remove the tumor.

It is strictly forbidden to squeeze the mammary glands with tight bandages in order to stop breast growth, since this is not only ineffective, but also dangerous due to impaired blood flow.

Conservative treatment without surgery

If gynecomastia is caused by high level estrogens, then for its treatment drugs from the antiestrogens group are used, such as Tamoxifen, Clomiphene, Danazol. In addition, in addition to antiestrogens, drugs from the aromatase inhibitor group, such as Testoplakton or Thiamine bromide, are used for therapy. In addition to drugs that suppress estrogen activity, injections of vitamin B1 and Aevita are used in periodic courses lasting 20 days. Both antiestrogens and aromatase inhibitors are used long courses for a maximum of 2 years. If after 2 years a satisfactory result of conservative therapy has not been obtained, then surgery gynecomastia.

If gynecomastia is caused by partial androgen deficiency, then testosterone and human chorionic gonadotropin preparations in combination with Halidor are used for treatment. In addition, to enhance the effect hormonal drugs additionally possible in complex treatment include drugs that improve cerebral circulation (Cavinton, Cinnarizine, Actovegin, etc.), vitamins and metabolites (vitamin B6, ATP, glycine, etc.).

Surgery to remove gynecomastia

Surgery to remove gynecomastia is performed only if conservative therapy is ineffective and if the patient wishes to remove enlarged mammary glands. It must be remembered that the chest after surgery may look even worse than before, so when deciding on surgical removal mammary glands should be carefully considered and weighed. To maximize the likelihood of a successful outcome of the operation, it is necessary to carefully select a surgeon who has experience in performing these types of surgical interventions.

Currently, the following types of operations are performed to remove gynecomastia:

Subcutaneous mastectomy with areola preservation. An incision is made in the area of the areola, and through it all the tissue of the enlarged mammary gland is removed, after which the skin is sutured, forming a beautiful outline of the chest. During this operation, the nipple areola is preserved, the scar is made inconspicuous, which allows for a good aesthetic effect after surgical treatment.
Subcutaneous mastectomy with liposuction. An operation similar to that described above, but differing in that during the intervention fatty tissue is removed. The operation is suitable for the treatment of false gynecomastia.
Endoscopic mastectomy. The operation is performed using endoscopic equipment, during which all tissues of the enlarged mammary gland are removed. Since access for surgery is through a puncture in the armpit, the scar is hardly noticeable and the nipple is preserved, which allows for excellent cosmetic results.

The choice of operation is made by the doctor based on individual characteristics person and characteristics of gynecomastia.

After operation

After surgery to remove gynecomastia, you need to wear shapewear for several days to create a smooth breast surface and reduce excess skin. Since during the operation they are not removed The lymph nodes and muscles, then it is considered low-traumatic, as a result of which men are discharged from the hospital home 2–3 days after surgery. Complete tissue healing after surgery occurs within 3 to 6 weeks, during which it is necessary to avoid heavy physical activity, overwork, etc. After tissue healing, it is necessary to exercise physical exercise aimed at developing and restoring the functions of the pectoral muscles.

Cost (price) of surgery to remove gynecomastia

The cost of surgery to remove gynecomastia ranges from 40,000 to 120,000 rubles. The price range is due to management policy medical center and its form of ownership (private or public). However, when choosing a medical institution for the removal of gynecomastia, it is recommended to focus primarily not on the cost of the intervention, but on reviews of the doctor who will perform the operation.

Which doctor should I contact about gynecomastia removal?

To remove gynecomastia, it is recommended to consult a mammologist-surgeon, plastic surgeon or surgeon general practice. Unfortunately, in the CIS countries, surgeons have little experience in performing surgery to remove gynecomastia, so surgical intervention can be performed efficiently at a high technical level, but with unsatisfactory cosmetic results, which should be taken into account at the decision-making stage.

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Before use, you should consult a specialist.

Content

Today, a very common disease is gynecomastia in men, which is manifested by enlarged mammary glands. Previously it was rarer, but Lately The number of people suffering from this problem has increased significantly. In a broad sense, the cause of this pathology is hormonal disorders with an excess of the level of female hormones estrogen over male androgens. You can learn more about the causes, signs and how to get rid of gynecomastia below.

What is gynecomastia in men

Translated from Greek this term means "breast" and "woman". From these concepts it is clear that gynecomastia is a disease in which the mammary glands develop according to female type. This pathology is typical only for men. The disease develops at any age. More often, this diagnosis is given to men 50-60 years old. This is due to age-related changes, which are characterized by processes of hormonal changes. Gynecomastia has several types:

True. With this form of the disease, the glandular or connective components of the mammary gland grow. This leads to an increase in its volume to approximately 20 cm. Liposuction will not help here, because connective and glandular tissue more dense. True gynecomastia is divided into physiological (in newborns, adolescents and the elderly) and pathological (caused by serious diseases).
False or pseudogynecomastia. This form of the disease is characterized by the proliferation of adipose tissue of the mammary glands. Occurs in obese men. Treatment here is carried out through liposuction and subsequent weight loss.
Mixed. In this case, all the structures of the mammary glands grow - glandular, fatty and connective. Sometimes the pathology can be one-sided.

Symptoms

One of the most obvious symptoms is breast enlargement. She becomes like a woman. In addition to visual signs, there are other signs of gynecomastia in men:

decreased libido;
enlarged axillary lymph nodes;
feeling of heaviness and fullness in the chest;
problems with potency;
itching in the chest area;
swelling and hardening of the mammary glands;
an increase in the size of areas, a change in their color to a darker one;
discharge of clear liquid from the nipples when pressed;
change in voice timbre;
emotional instability;
reduction of male pattern hair.

Causes

Certain forms of gynecomastia have their own causes. In general, breast enlargement is facilitated by an increase in the level of the female sex hormone estrogen. These changes are caused by hormonal imbalance, which may be a consequence various diseases. The causes of gynecomastia also depend on the age of the man:

In newborns, swelling of the mammary glands is associated with the action of the mother's estrogens, which enter the womb. More often, this pathology goes away on its own after 2-4 weeks from birth.
In boys 12-14 years old, gynecomastia occurs in 30-60% of cases. More often it is bilateral and is caused by a temporary hormonal imbalance. The disease goes away on its own within 12-24 months.
In old age, gynecomastia can occur in many men 50-80 years old. She is connected with reduced level the hormone testosterone, over which female estrogen begins to predominate.

At a young age, gynecomastia develops more often due to more serious diseases. The first to note are pathologies of the genital organs, which are accompanied by a decrease in testosterone levels. Among them are:

congenital diseases - anorchia (absence of one or both testicles, Klinefelter syndrome, defect in testosterone synthesis;
acquired – injuries, testicular cancer, parotitis, orchitis.

An increase in the amount of estrogen, which causes breast growth, is also observed in some serious diseases, such as:

bronchogenic lung cancer;
feminizing adrenal tumor;
testicular tumor;
choriocarcinoma;
true hermaphroditism.

Glandular diseases may also be the cause. internal secretion or internal organs. In this case, gynecomastia is caused by:

chronic cardiac or renal failure;
hyperthyroidism;
cirrhosis;
obesity;
“renewed feeding” syndrome, when a person begins to eat after a long period of fasting;
dystrophy;
leprosy;
HIV infections.

Some medical supplies Side effects include gynecomastia. Among these medications are:

Reserpine;
Phenothiazine;
Theophylline;
Cordarone;
Spironolactone;
tea tree and lavender oil;
calcium channel blockers used to treat arterial hypertension;
tricyclic antidepressants.

Diagnosis of gynecomastia

If you experience a number of the listed symptoms, you should immediately consult a doctor in order to diagnose the disease in time. On initial stage It is possible to treat gynecomastia in men without surgery. During the consultation, the specialist palpates the mammary glands, checking whether lumps are present. Diagnosis also requires examination of the testicles for the presence of a tumor or injury.

If hormonal dysfunction is suspected, hormone tests are prescribed: testosterone, prolactin, estrogen and human chorionic gonadotropin. For an even more detailed study and to exclude a number of diseases, patients may undergo the following studies:

Ultrasound of the mammary glands and scrotum;
radiography;
CT scan of the brain and adrenal glands.

Treatment of gynecomastia in men

After confirming the type of gynecomastia, the doctor prescribes a specific treatment for the patient. Today medicine offers several treatment options. In newborns, treatment is not required, because gynecomastia in them disappears in most cases on its own. In adult men, therapy begins with hormonal drugs. If it does not bring a positive effect, then surgical intervention is indicated, including removal of the mammary glands.

Without surgery

Since gynecomastia is caused by hormonal disorders in men, it is treated with drugs containing hormones. Although other medications are often used. It all depends on the age of the patient and the type of gynecomastia. Generally applicable the following groups medicines:

hormonal – for correction hormonal disorders in the body of a man;
bromocriptine – suppresses the production of prolactin by the pituitary gland, more often used to treat adolescents during puberty;
vitamins - used in combination with basic medications.

Drug therapy

If gynecomastia is caused by taking any medications, then you need to stop using them or reduce the dosage. In other cases, treatment is carried out medications, such as:

Testosterone. Indicated for patients with low level hormone of the same name. Often prescribed to older people.
Clomiphene. This is an anti-estrogen that suppresses the synthesis of the female sex hormone estrogen in the patient.
Tamoxifen. Used in more severe cases of male gynecomastia. Belongs to the group of selective estrogen receptor modulators.
Danazol. The drug is a synthetic derivative of testosterone. It reduces estrogen synthesis in the testicles.

Surgical methods

If drug therapy is not effective, surgical treatment is indicated. In case of true or mixed form, a mastectomy is performed. This is an operation to remove the breast and then correct the area under the nipples so that they do not collapse after the operation. For false gynecomastia caused by obesity, liposuction is necessary, during which all the fat is pumped out from the affected area. If the cause of gynecomastia is malignant tumor, then it is also removed through surgery.

Forecast

Gynecomastia has a favorable course in adolescents and newborns, because it almost always goes away on its own. In other cases, the outcome depends on the specific disease that caused breast enlargement in men. But even in severe cases, for example, with scarring, surgical methods help restore normal look mammary glands. In general, this disease is not so dangerous, but if it persists for a long time, it significantly increases the risk of developing complications, including cancer.

Prevention

It is impossible to prevent the development of gynecomastia in adolescents or newborns, because it is caused by hormonal changes. For adult men, it is important to control and not neglect their existing diseases. It is equally important to lead a healthy lifestyle, carefully select medications, and not abuse alcohol and especially drugs.

Video: breast enlargement in men

Attention! The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

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There are several types of gynecomastia in men. They differ in the composition of the tissues that form the enlarged breast.

It could be:

breast tissue (true gynecomastia);
adipose tissue();
both at the same time (mixed gynecomastia).

True gynecomastia requires special attention, since this type of disease indicates a significant imbalance of sex hormones.

In about half of patients, the problem is caused by a decrease in tissue susceptibility to androgens..

The tendency for breast growth is often inherited.

It also happens that gynecomastia develops at the stage of puberty and the volume of the mammary glands remains at the same level throughout life, while tests do not show any hormonal abnormalities in the body.

Note! Gynecomastia can develop in both breasts or just one.

Gynecomastia caused by obesity does not require therapy. carried out only at the request of the patient.

Symptoms of the disease

With true gynecomastia, a man is worried not only about the appearance of the mammary glands, but also about discomfort. The patient may experience heaviness, itching, soreness. The contact of nipples with clothing can be unpleasant.

The glands themselves are dense to the touch and have clear contours. The nipples may also be unusually large and have more intense pigmentation. The gland tissue is firmly connected to the chest muscles and skin.

There are three stages in the course of the disease:

The growth stage of the mammary glands, it lasts about four months. If you start on time drug treatment, the breast can completely “dissolve”.
Intermediate stage, its duration is from four months to a year. Breast tissue gradually matures, and conservative treatment becomes less and less effective.
Fibrous stage, when changes in the breast become irreversible. With the help of medications, you can slow down the progress of the disease, but it will not be possible to make already grown glands disappear.

Important! If you do not start conservative treatment of true gynecomastia during the first year of the disease, you will get rid of it in the future. big breasts It will only be possible through surgery.

Age groups

Breast growth can occur at any age. The mammary glands are very sensitive to the slightest fluctuations in the ratio of androgens and estrogens.

The slightest decrease in androgen activity can trigger breast enlargement.

Children and teenagers

Gynecomastia in newborns is a common and not dangerous phenomenon.

In about half of boys, swollen mammary glands can be noticed during the first month of life.

This is due to the fact that a small amount of maternal sex hormones that penetrated through the placenta remains in the blood of a newborn baby.

Also, some hormones enter the baby’s blood through breast milk.

Conservative and surgical methods are used to treat true gynecomastia in men.. involves an integrated approach. Firstly, you need to be cured of the underlying disease that caused the development of gynecomastia, and secondly, you need to establish hormonal balance in the body.

If the problem occurs while taking medications, drugs that reduce estrogen levels are used.

TO surgical intervention are resorted to when drug therapy has not produced the desired effect within two years, and the patient wants to reduce his mammary glands for aesthetic reasons.

In addition, surgery cannot be avoided if gynecomastia occurs due to tumor formation.

Attention! Some patients try to stop the growth of the mammary glands by squeezing them with tight bandages. This cannot be done: firstly, this method does not give any effect, and secondly, it causes disruption of blood flow, which increases the risk of malignant formations.

Conservative treatment method

During the course, conservative therapy is first used.

An operation to remove the mammary glands is performed in the case of a malignant formation in the gland or at the request of a patient who is dissatisfied with his appearance.

Conservative treatment started at early stage disease, is most effective and helps to reduce the mammary glands without surgery.

At the intermediate stage, the prognosis is less favorable: breast growth can be stopped, but it will no longer “resolve” on its own.

At the third stage, when the breast is fully formed, it can only be eliminated through surgery.

The following drugs may be involved in treatment:

antiestrogens (clomiphene, danazol);
testosterone and human chorionic gonadotropin;
aromatase inhibitors (testoplakton, thiamine bromide).

The doctor may also prescribe a course of injections of vitamins B1, A and E. To enhance the effect of hormone therapy, you can add drugs that improve blood circulation in the brain (Cavinton, cinnarizine, Actovegin).

Hormonal treatment does not always work good result, this is especially true for testosterone therapy. In addition, taking hormonal drugs is accompanied by side effects and increases the likelihood of developing cancer.

Surgical method of treatment

Surgical breast reduction is performed if medicinal method did not give any result.

What kind of surgery can the surgeon suggest??

Subcutaneous mastectomy. An incision is made in the area of the areola through which the gland tissue is removed, then the skin is sutured to give the breast an aesthetic shape.
Endoscopic mastectomy. During this operation, a puncture is made in the armpit area, and the tissue is removed using endoscopic equipment.

Anesthesia can be local or general. In case of use local anesthesia The patient can go home two to three hours after the operation; after general anesthesia, they will have to stay in the hospital for a couple of days.

Full recovery will take three to six weeks.

After surgery, you will have to wear shapewear for several weeks, which helps shape the aesthetic surface of the breast. The muscles and lymph nodes are not affected during the operation, so it is low-traumatic.

Useful video

For more information about gynecomastia in men, watch the video below:

So, a man who has discovered signs of gynecomastia should not hide under baggy clothes, but take care of his health.

True gynecomastia in men is a much bigger nuisance than an aesthetic defect that can be quickly eliminated with surgery.