What Are The Stages Of Gynecomastia?

Gynecomastia is a benign growth of breast tissue in men that can affect one or both breasts. This disorder is caused by an imbalance in estrogen and androgen activity. This occurs due to increased estrogen production or decreased androgen levels, which encourages breast tissue development. 

Gynecomastia is distinguished from fat deposition, which can develop as a result of general weight increase, by the growth of glandular tissue. It can be found in males of all ages, but often appears throughout the infant period, adolescence, and later adulthood.

Source: ALCS, Jaipur

Who is affected by Gynecomastia?

Gynecomastia is a very frequent disorder that affects men at various stages of life. Let’s take a deeper look at its frequency in various age groups:

  1. Newborns: Approximately 60-90% of male newborns are born with some degree of breast enlargement as a result of maternal estrogens. This normally resolves within a few weeks of delivery.
  1. Adolescents: During puberty, up to 65% of boys develop gynecomastia. This is often a transitory condition that disappears between six months to two years when hormone levels settle.
  1. Adults: Gynecomastia affects around 30-70% of males aged 50 to 69. The prevalence rises with age, due to the natural fall in testosterone production alongside an increase in estrogen levels.

What are the causes of Gynecomastia?

Gynecomastia can result from a variety of underlying factors that affect the hormonal balance between estrogen and testosterone. Understanding the reasons is essential for proper diagnosis and treatment. 

  1. Hormonal Imbalance: Gynecomastia is caused by an imbalance between estrogen and testosterone, with excess estrogen or decreased testosterone stimulating breast tissue growth. This imbalance can arise naturally during puberty, age, or as a result of other factors influencing hormone levels.
  1. Medications: Several medications can induce gynecomastia by disturbing hormonal balance. These include anti-androgens, anabolic steroids, antipsychotics, antidepressants, and ulcer treatments.
  1. Medical Conditions: Gynecomastia can be caused by hypogonadism, hyperthyroidism, renal failure, liver illness, and hormone-secreting tumors, all of which influence hormone production and metabolism.

What are the stages of Gynecomastia?

Understanding the stages of gynecomastia reveals the physiological changes, hormonal fluctuations, and emotional consequences. Understanding these stages gives clarity about the condition and allows for more targeted therapies for affected individuals.

  1. Grade I- Initial Development

Gynecomastia symptoms are frequently mild at first, but they can be upsetting. The key signs and symptoms include:

  • Tenderness and Sensitivity: One typical early sign is breast tenderness or sensitivity, particularly around the nipples.
  • Small Lump: A solid, rubbery lump or disc of glandular tissue may form behind the nipple. The lump is frequently moveable and more noticeable while the person is lying down.
  • Mild Enlargement: Breast size may grow slightly, affecting one or both breasts. The growth is normally symmetrical, however it might be more noticeable on one side.

In this stage of gynecomastia, just a minor enlargement of the breasts can be noticed. There is no excess skin growth. A grade 1 gynecomastia is difficult to diagnose since there are no specific indications or symptoms. There are no swelling tissues around the breasts. However, the region around the nipples begins to discolor, and the nipples take on the appearance of a cone.

  1. Grade II- Intermediate Development

During the intermediate stage of gynecomastia, glandular breast tissue increases significantly than normal in size. This growth frequently results in more obvious physical changes in the chest region.

  • Increased Breast Size: Breast tissue continues to grow, giving the breasts a more prominent look. The glandular tissue beneath the nipple may seem firmer and visible.
  • Nipple Changes: As the underlying glandular development progresses, the nipples may become more visible or thrust outward. As the breast tissue increases, the areolar diameter may rise as well.
  • Symmetry or Asymmetry: The growth might be symmetrical in both breasts or more apparent on one side, resulting in asymmetry.
  • Stretch marks (striae): May appear as the skin expands to accommodate the developing breast tissue, especially in circumstances of rapid expansion.

Grade II has no additional skin growth. However, males do experience an enlargement in nipples and larger breasts. Wearing loose shirts makes the chest feel stiffer. According to the physicians, this particular scenario is ideal for successful gynecomastia surgery.

  1. Grade III- Further Enlargement

In this stage of gynecomastia, males experience considerably swollen breasts and nipples and mild skin tissue growth. 

  • As gynecomastia advances, glandular and fatty tissue develop in the breast region, resulting in additional enlargement and perhaps more visible changes in breast size and form.
  • This stage can include a combination of enhanced glandular tissue development and the accumulation of adipose tissue (fat), resulting in bigger and more prominent breasts.
  • To manage hormone levels and reduce breast tissue growth, physicians may prescribe selective estrogen receptor modulators (SERMs) or aromatase inhibitors.

There is a considerable protrusion of breasts in this stage. The droopy breasts become visible even over loosely fitted clothes.

  1. Grade IV- Advanced Gynecomastia

Grade IV or Advanced Gynecomastia is characterized by Relatively large breast and excess skin growth.

  • Advanced gynecomastia can be identified by the excessive development of glandular and fatty tissue in the breast region, which causes considerable breast enlargement.
  • This condition can cause physical discomfort, pain, and difficulties with physical activity because of the size and weight of the breasts.
  • Severe gynecomastia can cause skin irritation, ulceration, and harmed lymphatic drainage.
  • Psychological distress might get worse, affecting relationships and general mental health.

Stage 4 or Grade IV is by far the easiest to identify. In this stage, the breasts grow significantly larger to the point of becoming women-like. The only and definite treatment for Grade IV gynecomastia is surgery.

Diagnosis of Gynecomastia

Gynecomastia can be diagnosed by using the following techniques:

  1. Clinical Examination : A healthcare professional does a physical examination to determine breast size, consistency, and symmetry. Palpation of breast tissue helps differentiate between glandular and fatty components.
  2. Imaging studies : Ultrasonography and mammography can be used to examine breast tissue and rule out other underlying problems. These imaging techniques help in determining the degree of glandular tissue growth and guiding treatment plans.
  3. Lab Tests : Blood tests are used to assess hormone levels, liver function, and kidney function. Identifying hormonal imbalances or medical conditions that contribute to gynecomastia.

Treatment for Gynecomastia

Gynecomastia treatment consists of a variety of methods that are suited to the severity and underlying reasons of male breast tissue development. They can be as follows:

  • Attentive Waiting : Monitoring gynecomastia development without prompt action, particularly in situations of physiological or pubertal gynecomastia. Regular follow-up visits to examine changes and determine if therapy is required.
  • Medical treatments : Pharmacological therapies, such as hormone therapy with SERMs or aromatase inhibitors, can help to limit breast tissue development. Medications used in response to underlying hormonal imbalances or medical disorders.
  • Surgical interventions : For more severe or advanced gynecomastia, extra breast tissue can be surgically removed via a mastectomy or liposuction. Consult with a surgeon for appropriate surgical methods and post-operative care.
  • Lifestyle Modifications : Promoting overall health through regular exercise and a well-balanced diet to help control weight and hormones. Avoiding substances known to worsen gynecomastia, such as alcohol, marijuana, and some medicines.

What is the fastest way to get rid of Gynecomastia?

Gynecomastia, in any stage, is a serious disorder that dramatically alters a man’s appearance. Sometimes it might lead to an inferiority complex and self-criticism. It may have an impact on someone’s emotional and psychological health, creating worry and tension, in addition to physical effects.

So it is not surprising that the patient would wish to get rid of it as quickly as possible. Non-surgical therapies include medications and hormone replacement. 

The most effective therapy for gynecomastia is surgery. When gynecomastia is identified, it is often too late for non-surgical treatment. Gynecomastia surgery is common among males over the age of fifty. The removal of the glands and liposuction are used to considerably reduce swollen breasts.

After surgery, it is critical to carefully follow the doctor’s instructions and medications. A specific diet and frequent exercise can help make this therapy even more effective.

For more information about gynecomastia and its treatment, visit the ALCS India website at https://alcsindia.com/ and schedule a consultation with Dr Sunil Arora.

Frequently Asked Questions (FAQs)

1. Can gynecomastia disappear on its own?

In certain situations, especially throughout infancy and puberty, gynecomastia may cure spontaneously when hormone levels stabilize. However, persistent cases often require medical or surgical intervention.

2. What are the risks of gynecomastia surgery?

Surgical risks include infection, hemorrhage, changes in nipple feeling, and scarring. Before undergoing surgery, consult with a trained surgeon about the potential risks and advantages.

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