The excessive growth of the male breast tissue is the most common benign disorder of the male breast, also known as gynecomastia. Common slangs or derogatory terms such as man boobs or moobs are often used, which can cause tremendous distress in self-conscious men.
Gynecomastia is generally caused by endocrine disturbances, which can be physiological in the different stages of a man’s life. Newborn gynecomastia occurs in almost all male infants, and resolves naturally. Persistent adolescent breast swelling is documented in 70% of teenage boys, which can be a source of embarrassment and distress, in addition to other growing pain.
Gynecomastia can involve one or both breasts. Man boobs are also commonly found in men above the age of 50, known as senile gynecomastia.
The prevalence of senile gynecomastia is believed to be under-reported, although it has seen a rise in recent years. The exact cause and the epidemiology are not fully understood. The utilisation of anabolic steroids, pesticides and plastics that mimics the estrogen has been widely implicated.
In older men, gynecomastia is thought to be associated with the natural decline in testosterone. Although gynecomastia is generally not life-threatening, the swellings in the chest can cause mild discomfort, emotional embarrassment amongst affected men and heightened anxiety about breast cancer. Breast cancers indeed affect men too, but this is exceedingly rare.
Male breast cancer is generally quoted to constitute about 1% of all breast cancer cases. It is estimated about two thousand new cases of male breast cancers are diagnosed in the US. The incidence of such cancer is rising, perhaps attributed to the genetic testing in female family members affected by the cancer.
The pathogenesis of such cancer is similar to female breast cancer, the etiology are predominantly hereditary genes of BRCA mutation, radiation exposure and alcohol abuse. The lack of awareness generally would delay seeking medical attention. Besides, the development of male breast cancer is generally less contained, as the lesion has less tissue to infiltrate before spreading. On that basis, the presence of excessive breast tissues in men with gynecomastia is arguably protective!
Gynecomastia is treated conservatively in most men, as they pose no medical or oncological threats. Men with mild cases of man boobs can rest assure and are advised to exercise while adopting a balanced diet. Moderate or severe cases may require medical or surgical interventions. There are medications prescribed to tackle gynecomastia in an “off label” basis. These are the same medication utilised for breast cancer such as tamoxifen. However, the success in the breast tissue reduction with the medications is not consistent. Radiations and surgeries, such as liposuction and mastectomy have also been carried out to help men cope with such embarrassment. However, the interventions are invasive and may not get the optimal results in many men.
