A diagnosis of gynecomastia will be needed before any treatment can start. A careful history and physical examination are necessary in order to evaluate the causes of gynecomastia. A breast ultrasound, Mammogram, and laboratory blood testing may be needed.
There may be breast enlargement and skin laxity of varying degrees, breast pain, nipple secretion, or combination, amongst the most common issues.
Primary gynecomastia has no known causative factors, and it's the most common type of gynecomastia, accounting for 25% of all cases. It is also called idiopathic. Secondary gynecomastia, is secondary to either illnesses or medications, or both, and the treatment of the offending condition may resolve the gynecomastia. If not, the breast enlargement persists.
Arrows: lower arrow points to the thick white gynecomastia tissue; superior arrows point to the projections of gynecomastia tissue into the fatty tissue, called dendritic projections.
When evaluating the gynecomastia patient, it is important to evaluate the psychological issues that may be associated with the condition, and the appropriate referral to an experienced professional, such as a psychiatrist, a psychotherapist or a counselor.
Experienced, specialized care is preferred, and online Blogs and Forums are not recommended either as a psychological support tool or as a source of accurate medical information.
The final step is medical treatment. After all, male breast overgrowth is not usually a desired outcome. A natural cause, such as newborn gynecomastia, needs only reassurance, education, and observation. Pubertal gynecomastia as well, as most cases resolve within three years of onset, on the average. But what of all other forms of this condition?
If the condition is due to medications or drug intake, stopping it should help cause regression of the gynecomastia. If liver, kidney, or hormonal diseases are the problem, treatment of the underlying condition may result in improvement of the gynecomastia.
The longer the gynecomastia goes untreated, the less likely it is to regress. It is estimated that untreated gynecomastia for a period of one year, will likely become persistent due to tissue changes that occur around the glandular tissue in the breasts. This is called hyalinization and fibrosis in the stroma - see the stroma (blue) around the glandular tissue in the photo below. Therefore, each person must be promptly evaluated when gynecomastia is suspected.
Once the underlying condition is identified, prompt intervention should help arrest the progression of the gynecomastia as well as promote either partial or total regression of the breast enlargement.
If there is pain associated with the enlargement of the breasts, the use of medications may help control the symptoms or suppress it entirely. Dihydrotestosterone, Clomiphene, and Tamoxifen, are some of the medications that have been studied for the medical management of gynecomastia, with some good results in treating the painful syndrome and promoting regression of the gynecomastia.
However, long-term studies are needed in this area to better evaluate the safety, side-effects, benefits, and complications of these and other drugs when treating gynecomastia. It is generally accepted that after one-year, medical treatment is of little benefit. You need to consult your Dr. to discuss your specific condition.
If the medical treatment fails, surgery is the next step to treat gynecomastia. Please click below for more information about the surgical treatment of gynecomastia.