At puberty, between the ages of 13 and 14, about 40% of boys are affected by gynecomastia. This benign pathology corresponds to hyperplasia (1) of the breast tissue and results mainly from a hormonal disorder. This swelling can be unilateral – affecting only one breast – or bilateral.
In a society where the physical plays a very important role, this apparent chest can be likened to a lack of virility and cause discomfort for the young boys concerned. Definition, causes, management… We take stock with Dr Géraldine Glatz, hospital practitioner of the visceral surgery department of the Lenval hospital in Nice.
What causes gynecomastia?
Breast enlargement is defined as breast feminization. It can be caused by a change or imbalance between female hormones (estrogen) and male hormones (testosterone). Indeed, during a man’s life, the hormonal balance undergoes variations and leaves the field open to estrogens, responsible for this feminization. This can happen at puberty, but also at birth or after the age of 50 (read elsewhere). In the latter case, it is completely normal physiological gynecomastia, linked to a lack of testosterone. In rarer situations, there are drug causes (taking products containing estrogens) or tumor causes (1% of cases).
What are the symptoms, besides breast enlargement?
This is the main sign. On the other hand, according to the degree of gynecomastia, there can be a real psychosocial impact and particularly at the time of puberty; in adolescents, the gaze and judgment of others is very important. This unsightly phenomenon can create shame or even discomfort. This is why, in adolescence, as soon as there is discomfort linked to swelling of the breast tissue, it is best to consult.
Is this hyperplasia transient?
In the vast majority of cases, neonatal and pubertal gynecomastia are regressive: they disappear when the adolescent’s puberty is over. Nevertheless, sometimes the swelling of the breast tissue persists. In 25% of situations, persistent gynecomastia is said to be idiopathic, that is to say without any explanation.
In case of persistent gynecomastia in adolescents, what management?
We must already find the cause: hormonal, drug, tumor … For this, the pediatrician prescribes a breast ultrasound. Then, depending on the results, the patient will be referred to an endocrinologist for a hormonal assessment. Indeed, two situations must be distinguished: the increase in the mammary gland linked to gynecomastia or the excess of fatty tissue linked to overweight which corresponds to adipomastia (read below). It will also be necessary to carry out a testicular ultrasound to verify that there is no tumoral process. A consultation with a psychologist may be necessary because the weight of this pathology is often hard to bear for young people and those around them. On the other hand, mammography has no place in the etiological assessment.
Is there a drug treatment?
To date, there is no effective medical treatment. In case of persistent gynecomastia, surgery remains the reference solution.
What are the conditions?
Patients are generally operated on around the age of 16-17. You have to wait until puberty has been over for about two years to see if the phenomenon regresses on its own. It is also necessary that the teenager’s weight has been stabilized for at least six months.
How is the operation carried out?
The operation, performed under general anesthesia, will consist of lifting the areola to resect the excess gland as far as the pectoral muscle. It is a one-night hospitalization with the establishment of a drainage, which is removed the next day. The threads resorb after a few weeks. The young patient will then have to wear a compression garment for one to two months. The operation involves very few risks, the main one being hematoma, as with any surgery. At Lenval Hospital, we perform 7 to 8 gynecomastia surgeries per year.
If the end of puberty comes late, can these young people be operated on as adults?
This operation can be performed at any age. It happens that boys are operated on at the age of 20 to be sure that puberty is over. In this case, they are taken care of in the same way in town or at the CHU.
1. It is an increase in the number of cells leading to an increase in volume.
Common at other times of life
Gynecomastia most often appears during puberty, around 13-14 years old. But there are two other periods in a man’s life when this breast tissue swelling can occur. First at birth. In fact, baby boys have breast tissue hyperplasia in 70% to 90% of
cas.
“It is simply the impregnation of estrogen from the mother to the fetus”, explains Dr. Glatz. In the vast majority of
cases, this phenomenon is transient and disappears in the first months of life.
Gynecomastia can also appear in men, around the age of
50 years. This concerns 30% of them. The cause then lies in hormonal changes. Thus, the level of testosterone (male hormone) drops at
advantage of estrogens (female hormones).
In the end, the vast majority of men will be affected by gynecomastia during their lifetime.
Distinct de l’adipomastie
Adipomastia is excess fatty tissue in the breasts of a man. It is not due to excessive glandular development and therefore has no hormonal cause.
“In recent years, there are more and more cases of adipomastia due to the sedentary lifestyle of the population and the increase in obesity and overweight among young people.“
Adipomastia can be treated by liposuction.
“I felt bad about myself and I was afraid of judgment”
18-year-old Leo had surgery to remove his bilateral gynecomastia in 2021. “I felt really bad about myself because of my dangling breasts. I thought I was fat and couldn’t understand why I didn’t have a more shapely and more masculine torso, says the young Cagness. When I was going at the pool or at the beach, I always kept a very large T-shirt to hide my chest. I haven’t bathed for three years! I always found excuses not to find myself in a bathing suit. I was ashamed and very afraid of the judgment of my friends. And especially that of girls.”
With the support of his mother, Leo decided to see an endocrinologist, and the surgical option was quickly considered.
“I didn’t hesitate for a second. I wanted to get rid of those boobs that were ruining my life.”
After the operation, Leo immediately felt better.
“It was a real relief. I redid my entire wardrobe and I swapped my XXL t-shirts for tighter and more fitted clothes. Today, I came out of my shell and felt freed from a weight. It’s like a rebirth.”