Gynecomastia (Man Boobs) in Singapore: Insights and Treatments for the 1 in 3 Men Affected

What is Gynecomastia?

Gynecomastia is a condition characterised by the enlargement of breast tissue in males, carrying with it a significant social stigma in Singapore’s rather-conservative society. This article aims to provide insights into the signs and implications of gynecomastia or “man boobs”, the most common male breast deformity worldwide.

What Does Gynecomastia Look Like?

Hormone imbalance between estrogens and androgens. Gynecomastia

• The normal male breast consists primarily of muscle with a thin overlay of fat tissue, shown in the diagram on the left side.
• The right side of the diagram represents gynecomastia, a condition characterised by an increase in both fatty and glandular tissues.
•  In gynecomastia, there’s a notable presence of glandular tissue beneath the nipple-areolar complex, which can extend outward in a semi-circular shape.
• This glandular tissue, primarily located beneath the nipple-areolar complex (the circular area surrounding the nipple, including the nipple itself and the areola), is typically not present in such volume in the normal male breast, where the pectoral muscle is more prominent and the amount of fat is usually less.

Gynecomastia Treatments

Liposuction

A surgical procedure that targets and removes excess fat in specific areas, including the breast area, to reduce size and improve contour. Male Breast Reduction, often achieved through liposuction, targets and removes excess fat in the breast area. This technique, distinct from mastectomy, focuses on reducing fat rather than glandular tissue and is a key component of cosmetic improvement for gynecomastia patients.

Mastectomy

The surgical removal of breast tissue, often performed to excise glandular tissue in gynecomastia cases, typically resulting in minimal scarring.

Hormonal Therapy

This treatment adjusts hormone levels to address conditions like gynecomastia caused by hormonal imbalances. Hormones like oestrogen and testosterone play crucial roles in the body; oestrogen affects breast growth, while testosterone influences traits such as muscle mass.

Radiation Therapy

Utilises high-energy rays to treat or control medical conditions, occasionally used to prevent tissue growth in specific cases, such as part of prostate cancer treatment.

Medication

Drugs such as tamoxifen or raloxifene are effective in adjusting hormone levels to reduce unwanted breast tissue. These medications specifically target the balance of hormones like oestrogen and testosterone to manage conditions related to their imbalance.

If you’re experiencing discomfort or self-consciousness due to gynecomastia or excess breast tissue, consider consulting with Covette Clinic.

Types of Gynecomastia

• Neonatal Gynecomastia in infants typically resolves as maternal hormones dissipate.
Pubertal Gynecomastia during adolescence reflects the body’s natural hormonal adjustments.
• Late-Onset Gynecomastia in adults often correlates with lifestyle factors and general health.
• True Gynecomastia refers to the growth of glandular breast tissue in males due to hormonal imbalance, leading to visible enlargement of the breasts
• Mixed Gynecomastia involves a combination of glandular tissue growth and excess fat deposition in the breast area, resulting in both glandular and fatty enlargement of the breasts.

Gynecomastia Causes

Hormonal Imbalance: At the core of gynecomastia is the disruption in the Oestrogen Testosterone Ratio. This delicate balance between oestrogen and testosterone levels is crucial, with imbalances affecting individuals at various life stages. An increased ratio of oestrogen to testosterone is specifically linked to the development of gynecomastia.
Medications and Health Conditions: The use of specific medications (such as anti-androgens and steroids) and certain health conditions (like liver or thyroid disorders) can lead to hormonal shifts that result in gynecomastia. These conditions directly influence the body’s hormone levels, underlining the link between gynecomastia and overall health.
Obesity: Causes gynecomastia by converting testosterone into oestrogen, influencing the body’s hormonal balance.
Tumours: Can directly cause gynecomastia by secreting hormones or affecting hormone-producing organs, indicating a specific cause and highlighting broader health risks.

Congenital Disorders: Conditions such as Klinefelter syndrome, a genetic condition in males resulting from an extra X chromosome that can affect physical and cognitive development, directly affect hormonal balance and are direct causes of gynecomastia.

Understanding the underlying cause of gynecomastia is crucial for effective treatment. While the condition can be embarrassing, you don’t have to suffer in silence. Contact Covette Clinic for an appointment today.

Gynecomastia Risk Factors

• Health Conditions: Liver disease, kidney failure, and thyroid disorders are risk factors due to their impact on hormone production and balance.
Obesity: Acts as a risk factor by predisposing individuals to a hormonal imbalance that can lead to gynecomastia.
• Malnutrition and Starvation: These conditions affect hormone levels by reducing testosterone, making them risk factors for hormonal imbalance.
• Environmental Oestrogen Exposure: Increases the risk of gynecomastia by potentially altering hormone levels, though it is not a direct cause unless combined with other factors.

Grades of Gynecomastia

Classification of Gynecomastia Man Obesity with fat tissue on the chest comparison with normal chest

Gynecomastia’s progression is categorised into four distinct grades, each reflecting an increase in severity:

 

Grade 1: Minimal Visibility – The breast enlargement is slight, mostly around the nipple, hardly noticeable under clothes, with no skin excess.
Grade 2: Moderate Changes – Enlargement becomes more evident. Sub-categories include:
    •  2A: Without significant skin excess, the chest contour begins to alter subtly.
    •  2B: Some skin excess is present, initiating a mild sag.
Grade 3: Advanced Enlargement – Breast tissue and skin excess are clearly visible, closely mimicking female breast contours, with noticeable sag.
• Grade 4: Extreme Enlargement – Characterised by significant tissue growth and skin excess, resulting in marked sagging and feminization of the chest.

 

Unsure if you have Gynecomastia? Seek a professional opinion from the doctors at Covette Clinic.

Gynecomastia Symptoms

• Swollen Breast Gland Tissue: The primary symptom, presenting as an increase in glandular tissue size, leading to a puffy or enlarged appearance of one or both breasts.
• Breast Tenderness: Varies from mild discomfort to pronounced pain, characterised by sensitivity in the breast area.
• Symmetrical Enlargement: Both breasts may enlarge equally, maintaining similar shape and size.
• Asymmetrical Enlargement (Unilateral Gynecomastia): One breast may become noticeably larger than the other, resulting in an uneven chest appearance.
• Nipple Changes: Includes size increase, heightened sensitivity, or unusual appearance.
• Breast Softness: The breast area may feel softer due to the presence of increased glandular tissue.

How is Gynecomastia Diagnosed?

Gynecomastia is diagnosed through a combination of methods to accurately understand the cause and rule out other conditions. Here’s an elaboration on the types of tests done.

Physical Examination: A thorough inspection focuses on breast tissue enlargement, sensitivity, and categorization (fat vs. glandular). Additionally, the examination extends to the abdomen and genitals to check for signs that may indicate hormonal imbalances or the presence of tumours.

    The Pinch Test for gynecomastia is a diagnostic method where the examiner pinches the skin and tissue around the male breast area. If a firm, rubbery disk of tissue is felt under the nipple, it may indicate the presence of gynecomastia, distinguishing it from fat.

• Medical History Review: Understanding the patient’s health background is vital. This includes the duration of breast enlargement, medication changes, substance use, and family health history, particularly regarding breast cancer or endocrine disorders.

 Diagnostic Testing:

    Blood Analyses: Essential for evaluating hormone levels (testosterone, oestrogen), liver and kidney function, and thyroid hormone levels, contributing to a comprehensive hormonal profile.

    Imaging Tests:

            Mammography and Ultrasound: Primary tools for distinguishing gynecomastia from other conditions such as lipomas or breast cancer by analysing tissue density and structure.
            MRI and CT Scans: Offer detailed images for complex cases, aiding in the assessment of glandular tissue and excluding other underlying issues.
            Testicular Ultrasound: Useful in detecting abnormalities like tumours that could influence hormone levels.

Biopsy: In select cases, a biopsy confirms the diagnosis by analysing a tissue sample, ensuring that breast cancer is ruled out.

These diagnostic steps are crucial in confirming the presence of gynecomastia, understanding its cause, and planning the appropriate treatment.

Gynecomastia Surgery Benefits

• Comfort in Your Own Skin: Post-surgery, anticipate feeling more at ease and confident without a shirt, diminishing feelings of self-consciousness and often enhancing overall self-assurance.
• Alleviates Physical Discomfort: Reduction of tenderness in the breast area is a significant benefit, enhancing your comfort.

Refines Your Appearance: Male breast reduction surgery results in a more traditionally masculine chest contour.

Improves Clothing Fit: Post-surgery, even a simple t-shirt tends to fit better and more comfortably, complementing your body’s new shape.

Am I A Good Candidate For Male Breast Reduction Surgery?

Gynecomastia Symptoms: Close-up of Male Chest on White Background | Medical Condition Concept

Symptoms indicating gynecomastia: You may notice excess breast tissue, which is not responsive to diet or exercise.
Stable Weight: Your weight should be stable before considering surgery.
Health Status: You must be in good general health without serious medical conditions.
Hormonal Stability: Optimal hormone levels should be maintained; hormonal changes can complicate results.
Medications: Inform your surgeon about medication use, especially steroids or anabolic steroids.
Lifestyle: Non-smokers with a commitment to a healthy lifestyle, including regular exercise, are ideal.
Expectations: Having realistic expectations about the outcome is crucial.
Obesity: If obesity is present, weight loss is advised before surgery to achieve better results. Significant weight loss can lead to changes in body composition and the distribution of breast tissue, potentially reducing the extent of surgery needed.

Don’t keep guessing. Let a medical professional from the Covette Clinic advise you on your suitability for surgery. Reach out to our dedicated team now.

Gynecomastia Risks

Long-term gynecomastia risks include:

Hormonal Imbalances: Excess oestrogen or low testosterone can cause persistent breast enlargement, often needing hormonal treatments to correct.
Medication Side Effects: Drugs for heart disease, anxiety, or steroids may worsen gynecomastia, with risk reduction possible through medication adjustment.
Health Conditions: Liver disease, kidney failure, or tumours can prolong gynecomastia, with management focusing on treating these conditions.
Obesity: High oestrogen from obesity can maintain gynecomastia; weight management helps in hormone balance and breast size reduction.
Age-Related Factors: Gynecomastia varies by age, potentially requiring hormonal or surgical treatments in adults.
Substance Use: Alcohol, marijuana, and steroids disrupt hormone levels, extending gynecomastia’s duration and severity. Substance reduction can improve conditions.
Overall Management: Addressing gynecomastia’s root causes reduces long-term risks, highlighting the role of medical advice and lifestyle adjustments.

Gynecomastia Complications

Physical impacts: Enlarged breast tissue can restrict activity due to discomfort and self-consciousness, potentially causing skin irritation and chafing.
Psychological impacts: Significantly affects self-esteem and body image, often leading to social withdrawal and increased anxiety and depression. This highlights the need for empathetic care.

How to Prevent Gynecomastia

While it’s not always possible to prevent gynecomastia, especially when it’s caused by factors outside of one’s control (such as genetics or certain medical conditions), there are steps individuals can take to potentially reduce their risk. These measures focus primarily on maintaining a healthy hormone balance and avoiding known risk factors:

1. Maintain a Healthy Weight: Obesity can disrupt hormone levels, increasing the risk of gynecomastia. Achieving and maintaining a healthy weight through a balanced diet and regular exercise can help manage hormone levels.
2. Review Medications: Some medications are linked to the development of gynecomastia. If you’re concerned about this risk, discuss alternative treatments with your healthcare provider. Do not stop or change any medication without professional advice.
3. Limit Alcohol and Avoid Illicit Drugs: Substances such as alcohol, anabolic steroids, marijuana, and heroin can affect hormone levels. Reducing alcohol consumption and avoiding illicit drug use can decrease the risk of developing gynecomastia.
4. Monitor Health Conditions: Conditions that affect hormone levels, such as liver disease, kidney disease, and hyperthyroidism, should be properly managed under the guidance of a healthcare provider.
5. Consider Environmental Factors: Exposure to oestrogens in the environment, such as certain plastics, pesticides, and personal care products, may contribute to hormonal imbalances. While it’s challenging to eliminate all exposure, being mindful of these sources can be beneficial.
6. Nutritional Support: Although no diet can prevent gynecomastia per se, consuming foods that support hormone balance may be helpful. This includes a diet rich in whole foods, vegetables, lean proteins, and reducing foods high in soy or other phytoestrogens, which may impact hormone levels in sensitive individuals.

Gynecomastia vs Male Breast Cancer vs Pseudogynecomastia

Here’s the differences between gynecomastia, male breast cancer, and pseudo-gynecomastia at a glance with this concise chart detailing their causes, symptoms, and treatments.

Feature Gynecomastia Male Breast Cancer Pseudogynecomastia
Definition
Benign glandular tissue proliferation due to imbalanced hormone levels.
Cancerous growth in male breast tissue.
Enlarged male breasts due to excess fat, not breast tissue.
Cause
Hormonal imbalances, medications, underlying health conditions.
Genetic mutations, lifestyle factors, exposure to oestrogen.
Obesity or significant weight gain.
Main Affected Tissue
Glandular breast tissue.
Breast tissue, potentially spreading to lymph nodes.
Fat tissue only.
Symptoms
Swollen breast gland tissue, breast tenderness.
Lump in the breast, changes to the skin or nipple, possible discharge.
Larger breasts without specific breast tissue lumps or tenderness.
Diagnosis
Physical exam, medical history, possibly imaging tests.
Physical exam, imaging tests, biopsy.
Physical examination, assessing body fat percentage.
Treatment
Observation, medication for underlying cause, surgery in some cases.
Surgery, radiation, chemotherapy, targeted therapy.
Weight loss, exercise, liposuction in some cases.

When to See a Doctor

• Persistent Swelling: If breast enlargement lasts more than two years or is accompanied by pain.
• Signs of Serious Illness: Such as nipple discharge or skin changes.
• Rapid Enlargement: Sudden or quick increase in breast size warrants medical evaluation to rule out other conditions.
• Asymmetry or Lump: One breast significantly larger than the other or the presence of a noticeable lump.

Conclusion

Dealing with gynecomastia can take a toll on one’s self-esteem, making some feel paiseh about their appearance. But remember, you’re not alone on this journey. It’s important to recognize that seeking help and talking about your condition doesn’t mean you’re weak; rather, it shows strength and the desire to take charge of your health. Take that first step today by reaching out to Covette Clinic!

Frequently Asked Questions

1. How Common is Gynecomastia?

Gynecomastia is very common, affecting 60-90% of newborns, 50-60% of adolescents, and up to 70% of men aged 50-69.

2. What Foods Reduce Gynecomastia?

Foods high in zinc like oysters and beans.

Cruciferous vegetables such as bok choy, cabbage, and kale to balance oestrogen.

Lean proteins such as chicken, fish, and tofu to support hormone balance.

3. Can Gynecomastia Go Away With Exercise?

No, while exercise can reduce body fat and possibly decrease the appearance of gynecomastia, it does not directly address the glandular tissue responsible for the condition.

4. Which Exercise is Best For Gynecomastia?

Push-ups to strengthen chest muscles.
Bench press (inclined and flat) for upper body strength.
Cardio exercises for overall fat reduction.

5. Can Increasing Testosterone Get Rid of Gynecomastia?

Not typically. Boosting testosterone may alleviate gynecomastia in some cases, but must be carefully managed by a healthcare provider to address the condition’s root cause effectively.

6. Does Ethnicity Affect Risk of Gynecomastia?

Yes. In Singapore, ethnicity may influence gynecomastia risk due to varying genetic factors and hormone levels:
Studies suggest higher prevalence among Malay and Indian ethnicities.
Genetic predispositions and hormonal differences contribute to varying risks.
Understanding ethnic influences aids in tailored prevention and management strategies.

7. Will Breasts From Gynecomastia Grow Back?

Yes, breasts from gynecomastia can regrow if the underlying cause, like hormonal imbalances or medication effects, persists or reoccurs. Maintaining a healthy lifestyle and managing medical conditions are crucial to prevent recurrence.

8. Can You Massage Away Gynecomastia?

No, massaging the breast area cannot eliminate gynecomastia. Gynecomastia typically requires medical treatment, such as medication or surgery, to effectively reduce or remove the glandular tissue.

Medical References

Dickson, G. (2012, April 1). Gynecomastia. AAFP. https://www.aafp.org/pubs/afp/issues/2012/0401/p716.html

 

Sansone, A. et al. (2016). Gynecomastia and hormones. Endocrine, 55(1), 37–44. https://doi.org/10.1007/s12020-016-0975-9

 

Swerdloff, R. S., & Ng, J. C. M. (2023, January 6). Gynecomastia: etiology, diagnosis, and treatment. Endotext – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK279105/

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