Gynecomastia - Types & Stages

Gynecomastia, or ‘male boobs,’ is a medical condition that describes the enlargement of the male breast tissues in men of all ages, from teenagers and young adults to middle-aged and elderly men. The most common cause of gynecomastia is hormonal imbalance during puberty. It can also be caused by age-related decreases in testosterone levels, cancer treatment, and liver or kidney failure, among other causes. 

Whatever the cause of gynecomastia may be, it is safe to say that it can cause a lot of physical and emotional discomfort for men. Gynecomastia shows its symptoms in men in different ways. Therefore, there are several different types of gynecomastia. Additionally, like most medical conditions, gynecomastia progresses, and its symptoms become more severe when the condition is unable to resolve itself because of either lack of treatment or ineffective treatment. 

Types of Gynecomastia and Their Treatment

Gynecomastia, or enlargement of male breast tissue, can be caused by several contributing factors. For instance, natural hormone changes, cancer and HIV medication, alcohol and drug abuse, and various health conditions like malnutrition, obesity, thyroid, and liver and kidney failure can cause gynecomastia. Due to these factors, symptoms can vary from breast enlargement to tenderness, swelling, and even fluid discharge. The following is a list of gynecomastia types- 

Glandular Gynecomastia

Glandular gynecomastia refers to the enlargement of the male breasts due to excessive growth of the glandular tissue in the chest. This type of gynecomastia is extremely common among men who participate in professional or amateur bodybuilding. This is because many bodybuilders tend to consume anabolic steroids to help them build muscle by increasing their stamina. However, prolonged and unregulated consumption of anabolic steroids leads to hormonal imbalance. 

Men with this condition will either experience enlargement in both breasts or just one, resulting in uneven breasts. To treat this condition, the patient must undergo a combination of different types of gynecomastia surgery, namely surgical excision and liposuction. The surgery tends to involve removing the enlarged glandular tissue to achieve the ideal male chest contour. 

In the case of glandular gynecomastia, exercise is not an effective treatment option as the breast enlargement is caused by the overgrowth of glandular tissue and not excessive fat deposits.

Pseudo Gynecomastia

Pseudo or fatty gynecomastia is the enlargement of breasts due to excess accumulation of adipose tissue. Excessive fat deposits in the breasts could be triggered by genetics, obesity, a sedentary lifestyle, poor diet, and sudden weight gain. Unlike glandular gynecomastia, in pseudo gynecomastia, men do not develop a rubbery lump under their breasts. Instead, the breasts have a soft, doughy texture. Additionally, the patient will also notice enlargement of other parts of their body, as fat deposits in other parts as well. 

Treatment for pseudo-gynecomastia entails making several lifestyle changes. It can include dietary changes, exercise plans, and quitting smoking and consumption of alcohol. It is possible that even after successfully making these lifestyle changes, the breasts still seem enlarged. In that case, you would have to consider surgery as an option. Dr. Ritesh Anand, a leading cosmetic and plastic surgeon, prefers to use a combination of surgical interventions to remove the fat and reposition the nipples for the ideal masculine chest.

Pathological and Physiological Gynecomastia

Pathological gynecomastia refers to the enlargement of breast tissues due to endocrine disorders, consumption of certain medications, alcohol and drug abuse, systemic diseases, genetic disorders, and tumor growth. Enlargement of the breast tissue can occur rapidly or very slowly depending upon the severity of the medical condition causing it. Furthermore, it is accompanied by a number of symptoms, like weight loss, tremors, extreme fatigue, and excessive sweating. 

On the other hand, physiological gynecomastia is caused due to hormonal imbalance as a child, adolescent, or old man. In this case, both breasts tend to become large, and a small rubbery mass beneath the nipple can be felt. In the case of babies and adolescents, the condition tends to resolve over time without the need for treatment. Healthy older men can easily resolve the issue by pursuing testosterone therapy. 

Asymmetric Gynecomastia

As the name suggests, asymmetric gynecomastia defines the uneven enlargement of breast tissue. In the case of asymmetric gynecomastia, one breast tends to be noticeably larger than the other breast. The cause of the asymmetry is unknown. However, in most cases, the root cause of the enlargement is hormonal imbalance. Gynecomastia surgery types such as glandular tissue removal and liposuction might be employed to achieve symmetry. 

Bilateral Gynecomastia

Bilateral gynecomastia is characterized by the enlargement of both breasts. More or less, the enlargement caused is symmetrical in both the breasts. There is a rubbery mass beneath the breast that causes the enlargement. While it is typically painless, men can experience both physical and emotional distress due to drastic changes in their appearance. 

Bilateral gynecomastia is extremely common amongst pubescent boys and men above the age of 65. In adolescent boys, it occurs due to hormone imbalance and generally resolves itself after a few years. However, in older men, it occurs due to low testosterone levels and can be fixed only with medical intervention, like testosterone replacement therapy. 

Stages of Gynecomastia And How To Identify Gynecomastia Stages

In medicine, medical conditions, diseases, and infections are categorized into different stages. The goal of classifying medical conditions into stages is to help physicians evaluate the severity and the pathology of the condition. It also dictates the type of treatment required. For instance, surgical intervention or prescribing medication. Gynecomastia is also defined into different stages with varying identification markers. The primary gynecomastia stages are- 

Stage I

In stage 1 gynecomastia the breast is not extremely large and there is no excess skin around the breast. At this stage of gynecomastia, it is extremely hard to notice any difference from the normal form of the breasts. The patient doesn’t experience any physical discomfort or pain. 

At this stage, a medical professional can diagnose gynecomastia by checking the nipples. This is because the nipples start to develop minor discoloration and puffiness and take the shape of a cone. 

Stage II

At stage 2 of gynecomastia, there is considerable swelling under the breasts and nipples, but there is no excess skin. The condition is still unnoticeable externally. However, the patient can feel firmness and tenderness under their nipples. Some may even experience stiffness. The areolar continues to appear slightly enlarged and experience further discoloration. 

Treatment tends to depend on the cause of gynecomastia. Treatment usually involves hormonal therapy and lifestyle changes. For healthy men who don’t smoke or drink and suffer from a serious medical condition, surgical intervention can be considered at this stage if other means of treatment are not effective. 

Stage III

At stage 3 of gynecomastia, there is noticeable enlargement of the breasts with extra skin around the nipples and breasts. The excess skin and growth in breast tissue start to cause the nipples to droop. The width of the chest also expands significantly, leading to issues with clothing. At this stage of gynecomastia, breast enlargement, and sagging are even noticeable from underneath loose-fitted clothing. 

The breast contour also becomes more feminized. Treatment at this stage involves a combination of surgical and medical interventions. For instance, hormone replacement therapy is administered, and several lifestyle changes are made to prepare for tissue and fat removal surgery.

Stage IV

At stage 4 of gynecomastia, the breasts have expanded exponentially and have a very feminine appearance. There is also excessive skin growth around the areolas and the breast. The expansion of breasts is a huge cause for concern as it adversely affects physical appearance and quality of life. It is also indicative of a major issue that needs to be tackled immediately. Although, at this stage, the condition is extremely severe, it is still treatable with the right surgical interventions. It is recommended that medical treatment is sought as quickly as possible because the treatment is more effective at the earlier stages. 

Conclusion

Gynecomastia is a common medical condition that can affect men of all ages. To diagnose the underlying cause of gynecomastia, physicians tend to identify the gynecomastia types and stages of the condition. This helps them administer effective treatment, which tends to involve medication, hormone therapy, and lifestyle changes. The failure of these modes of treatment necessitates surgical intervention.

If you are a healthy man who is experiencing low self-esteem and confidence issues due to gynecomastia, then visit Dr. Ritesh Anand today. Dr. Anand has worked as a plastic surgery consultant at leading medical institutions like Dr. BL Kapoor Memorial Hospital, Maharaja Agrasen Hospital, and LA Midas Aesthetics for over a decade. He specializes in a wide range of cosmetic surgeries, such as liposuction, breast reduction, gynecomastia surgery, and blepharoplasty, amongst many others. Most importantly, Dr. Anand is renowned for offering personalized and discreet medical care to all his patients.