Gynecomastia, the benign enlargement of male breast tissue, is a common occurrence in adolescents as well as in middle-aged and older men.
While there are several reasons why men develop breast tissue, it is usually not a health concern, often resolves on its own, and is generally treatable, according to a clinical practice article appearing in the September 20 issue of the New England Journal of Medicine (NEJM).
The clinical practice article, a regular NEJM feature that focuses on a case history highlighting a common clinical problem, was authored by Glenn D. Braunstein, M.D., chair of the Department of Medicine at Cedars-Sinai Medical Center and an expert in gynecomastia and other hormone-related diseases.
“Nearly half of all men will experience breast tissue growth during their lifetimes, but many are unaware of it or are too embarrassed to even discuss the problem with their doctor,” said Braunstein. “Raising awareness of the condition – its causes, symptoms, treatments – may help more boys and men with gynecomastia be correctly diagnosed, and reassure them that they are not alone in experiencing this.”
Gynecomastia is characterized by the presence of a rubbery or firm mass extending concentrically from the nipples. About half the time, it is detected in both breasts. Other, different conditions present with similar symptoms: pseudogynecomastia, which is fat deposition without glandular proliferation, and is increasing along with the incidence of obesity in American men; and carcinoma of the breast, which is much less common. Breast cancer in men is usually not symmetrical to the nipple, is generally found only on one side, and may be associated with skin dimpling or nipple discharge. Several other conditions may also lead to breast enlargement in men, including neurofibromas, hematomas, and dermatoid cysts, but they are rare.
Gynecomastia can be physiologic (occurring normally during infancy, puberty and older age), or pathologic (due to drugs or disorders such as androgen deficiency, testicular tumors, hyperthyroidism, and chronic kidney disease). In adult men, 50 percent of cases are due to persistent pubertal gynecomastia or medication side effects, and an additional 25 percent have no known cause.