Enlarged breasts in men (gynecomastia)

Diagnosis

A diagnosis of gynecomastia is based on a review of your symptoms and a medical exam that includes a careful evaluation of your breast tissue, abdomen and genitals.

Tests

Your doctor will likely order tests to identify a possible cause of gynecomastia, to screen for possible breast cancer and to rule out other conditions. These may include:

• Blood tests
• Mammograms
• Computerized tomography (CT) scans
• Magnetic resonance imaging (MRI) scans
• Testicular ultrasounds
• Tissue biopsies

Conditions that cause similar symptoms

Your doctor will want to be sure that your breast swelling is gynecomastia and not another condition. Other conditions that can cause similar symptoms include:

• Fatty breast tissue (pseudogynecomastia). Some men and boys, especially those with obesity, have breast fat that resembles gynecomastia. This isn't the same as gynecomastia and doesn't need additional evaluation.
• Breast cancer. Breast cancer is uncommon in men but can occur. Enlargement of one breast or the presence of a firm nodule raises the concern for male breast cancer.
• A breast abscess. This is an infection of the breast tissue.

Treatment

Most cases of gynecomastia resolve over time without treatment. However, if gynecomastia is caused by an underlying condition — such as hypogonadism, malnutrition or cirrhosis — that underlying condition may need treatment.

If you're taking medications that may be the cause of gynecomastia, your doctor may recommend stopping them or substituting another medication.

In adolescents with no apparent cause of gynecomastia other than normal hormone changes during puberty, the doctor may recommend periodic reevaluations every three to six months to see if the condition improves on its own. Gynecomastia in adolescents often goes away without treatment in less than two years.

Treatment may be necessary if gynecomastia doesn't improve on its own or if it causes significant pain, tenderness or embarrassment.

Medications

Medications used to treat breast cancer and other conditions may be helpful for some men with gynecomastia. They include:

• Tamoxifen (Soltamox)
• Aromatase inhibitors, such as anastrozole (Arimidex)

Although these medications are approved by the Food and Drug Administration, they have not been approved specifically for use in people with gynecomastia.

Surgery to remove excess breast tissue

If enlarged breasts are significant and bothersome even after initial treatment or observation, your doctor may advise surgery.

Two gynecomastia surgery options are:

• Liposuction. This surgery removes breast fat but not the breast gland tissue itself.
• Mastectomy. This type of surgery removes the breast gland tissue. The surgery is often done using only small incisions. This less invasive type of surgery involves less recovery time.

Coping and support

For men, enlarged breasts can be stressful and embarrassing. Gynecomastia can be difficult to hide and a challenge to romantic relationships. During puberty, gynecomastia can make boys a target for teasing from peers. It can make activities such as swimming or changing in the locker room traumatic.

Whatever your age, you may feel like your body has betrayed you and you may feel unhappy with yourself. These feelings are normal, but to help you cope you can:

• Get counseling. Talk therapy can help you avoid anxiety and depression caused by gynecomastia. It can also help you communicate with your partner or family members so that they understand what you're going through.
• Reach out to your family and friends. You may feel embarrassed to talk about gynecomastia with the people you care about. But explaining your situation and asking for support will likely strengthen your relationships and reduce stress.
• Connect with others who have gynecomastia. Talking with men who have had a similar experience can help you cope. Websites such as Gynecomastia.org provide a forum for connecting with others who have the condition.