Causes & Grades

Causes of Gynecomastia

Developmental Gynecomastia or Primary Gynecomastia

Most male breasts occur as a developmental abnormality and is not a disease.

The male breasts/ puffy nipples occur due to abnormal accumulation of breast tissue (glandular tissue) which is usually in combination with excess fat tissue.

The abnormal development of breast tissue occurs during puberty.

During puberty there is a fluctuation in hormonal levels. The female hormone, estrogen, is responsible for the growth of breast tissue. During puberty, the levels of this hormone may be increased or the peripheral availability of this hormone may become higher. This results in the formation of abnormal breast tissue in men. 

The hormonal levels usually normalize in a few years, but the glandular tissue persists as gynecomastia.

The gynecomastia size increases when there is weight gain- the fat cells enlarge. Conversely, when a person with large male breasts loses weight, there will be some reduction in the breast size too, but it will not disappear because the glandular tissue will remain as it is. 

Other causes for gynecomastia-

Male breasts can occur in certain diseases like 

  •  Liver cirrhosis
  •  Alcohol abuse
  •  Atrophy of the testes
  •  Tumors/ congenital diseases causing hormonal imbalance.

Male breasts can occur in obesity from only excess fat accumulation also called as "pseudo Gynecomastia". 

Gynecomastia can result as a side effect of certain medicines like anabolic steroids, cimetidine, spironolactone, ketoconazole and many others. Fortunately, most of these medicines are not very commonly prescribed.

Gynecomastia can also occur in certain congenital diseases like Klinefelter's syndrome.

CLASSIFICATION OF GYNECOMASTIA

Male breasts can be classified based on content or on the size. 

Depending on the tissue content, Gynecomastia could be-

    Glandular only

    Fatty glandular

    Predominantly fatty (Pseudo Gynecomastia)

Based on size, gynecomastia can be classified as follows-

Grade 1- Minor but visible breast enlargement without skin looseness

Grade 2 A- Moderate breast enlargement without skin looseness

Grade 2 B- Moderate breast enlargement with minor skin looseness

Grade 3 - Severe breast enlargement with skin looseness that resembles a female breast.

Most gynecomastia treated in India belong to Grades 1, 2A and 2B. These cases are completely treatable by minimal access surgery.