Gynecomastia is the common, non-cancerous enlargement of glandular breast tissue in males. This physical change typically results from an altered balance between male hormones (testosterone) and female hormones (estrogens). Diagnosis and successful management often rely on a team of medical professionals. Since causes range from normal physiological changes to serious medical conditions, seeking professional diagnosis is the first step toward effective treatment.
The Role of Primary Care Physicians
A Primary Care Physician (PCP) or General Practitioner is typically the initial point of contact. The physician conducts a history and physical examination to distinguish true gynecomastia from pseudogynecomastia (enlargement solely due to excess fatty tissue). The physical exam involves palpating the breast tissue to identify the rubbery or firm mound characteristic of glandular proliferation.
The PCP screens for serious underlying causes driving the hormonal imbalance, including reviewing all medications and supplements that might induce the condition. Initial blood work assesses systemic health, including tests for liver, kidney, and thyroid function.
Initial hormone testing measures serum levels of total testosterone, estradiol, and luteinizing hormone (LH) to pinpoint the imbalance. If a rare, hormone-producing tumor is suspected, tests for human chorionic gonadotropin (hCG) and alpha-fetoprotein (AFP) are also performed. The PCP then determines if the patient requires referral to a specialist for further investigation or medical management.
Endocrine Specialists and Medical Treatment
If initial screening suggests a hormonal or metabolic cause, the patient is referred to an Endocrinologist. This specialist conducts a detailed hormonal profile, analyzing hormones like prolactin, follicle-stimulating hormone (FSH), and sex hormone-binding globulin (SHBG). The goal is to identify and address the root endocrine disorder, such as hypogonadism or increased estrogen conversion.
Medical management is the preferred non-surgical approach, especially for recent-onset gynecomastia (typically less than twelve months) before the tissue becomes fibrotic. Medications counteract the effects of excess estrogen on the breast tissue. Selective estrogen receptor modulators (SERMs), such as Tamoxifen, are commonly used for painful or recent cases by blocking estrogen receptors.
If low testosterone is the primary issue, hormone replacement therapy may be considered. This requires careful monitoring, as external testosterone can convert into estrogen, potentially exacerbating the condition. If the condition is long-standing or fails to respond to drug therapy, surgical intervention becomes the more viable option.
Surgical Intervention and Plastic Surgeons
When gynecomastia is long-standing, fibrotic, or medical management has failed, a Plastic Surgeon provides the definitive physical correction. This specialist provides the aesthetic contouring necessary to achieve a flat, masculine chest profile. The surgical technique depends on tissue composition and skin laxity.
For cases predominantly involving excess fat (pseudogynecomastia), liposuction alone may be used through small incisions. Most true gynecomastia cases, however, involve a combination of fat and dense glandular tissue, necessitating a combined approach. The surgeon performs liposuction first, followed by direct surgical excision to remove the firm glandular disc that resists traditional liposuction.
Glandular tissue excision is often performed through a small incision along the edge of the areola (Webster incision), which conceals the scar. In severe cases involving significant enlargement or stretched skin, the surgeon may need to remove skin and reposition the nipple-areola complex.
Follow-Up and Long-Term Monitoring
Continuity of care is necessary following treatment to ensure the best outcome and monitor for recurrence. After surgery, the patient follows up with the Plastic Surgeon to monitor incision healing, manage scar tissue, and oversee the use of a compression garment. The garment is worn for several weeks to minimize swelling and support the new chest contour until the final aesthetic result is apparent.
If gynecomastia was linked to an underlying hormonal condition, the Endocrinologist or PCP continues to monitor hormone levels to prevent future imbalances. The primary care team also manages the psychological impact, offering support or referring to mental health professionals if body image issues persist. Maintaining a stable weight and a healthy lifestyle is recommended, as weight fluctuations can increase the risk of recurrence.