Gynaecomastia: male breast enlargement, causes, treatment and how long it lasts

Gynaecomastia is the benign (non-cancerous) enlargement of male breast tissue, on one or both sides. The NHS says it affects men and boys and that the main symptom is getting bigger breasts than usual, which may also look swollen or feel sore.

Men have a small amount of breast tissue under the nipples. Luton and Dunstable University Hospital explains that swelling of this tissue can occur as a result of hormonal changes, that it can cause just a small lump or a larger swelling, and that it is a harmless condition but can be embarrassing and uncomfortable.

Royal United Hospitals Bath notes that some men and boys have fat on their chest that makes it look like they have breasts, and that this is a different condition from gynaecomastia.

University Hospitals Sussex says gynaecomastia is usually caused by changes in the levels of the hormones oestrogen and testosterone, which is very common during puberty or as men reach older age. Royal United Hospitals Bath describes it as a change in the balance of these two hormones.

The NHS lists the following possible causes.

Royal United Hospitals Bath says gynaecomastia is common in teenage boys, with as many as 65% of 14-year-olds having it. It says that if you are a teenager you probably will not need tests and that the breast enlargement will probably go away on its own in 2 or 3 years; in 90% of teenage boys it goes away in less than 3 years.

The NHS says that when gynaecomastia happens in newborn babies, or when it is caused by puberty, it usually goes away by itself over time. University Hospitals Sussex adds that if it occurs during puberty, it usually resolves as boys get older and their hormone levels stabilise.

University Hospitals Sussex says that at a clinic appointment a doctor will ask about your medical history, including medications, and examine you. Tests may then include a mammogram (breast X-ray) and/or an ultrasound scan, and in rare circumstances a biopsy. You may also be asked to have a blood test.

Luton and Dunstable University Hospital says the chest area is examined and possibly the abdomen to look for liver enlargement and the testicles to look for swellings, because gynaecomastia is sometimes caused by hormonal changes resulting from liver problems or testicular lumps. It says that most swellings of male breast tissue are harmless, but a referral to a breast unit is often made to be absolutely certain.

The NHS says gynaecomastia is often harmless and may not need treatment. If it is a problem for you, your GP may recommend medicines that reduce or increase certain hormones, or losing weight if you are overweight. If a condition is the cause, treating it may help reduce the size of the breasts.

Luton and Dunstable says most cases settle over time and nothing needs to be done. If any drugs are contributing then stopping them will help, as will reducing alcohol and losing weight. It says tablets such as tamoxifen and danazol are sometimes used but are not licensed for this purpose and can have serious side effects, so are only used if felt to be necessary. University Hospitals Sussex says a medicine is very occasionally prescribed, as a short-term medication if there is tenderness.

It is important not to change or stop prescribed medicines without medical advice, according to University Hospitals Sussex.

The NHS says surgery can reduce the breasts if other treatments have not worked, but may not be available on the NHS. Royal United Hospitals Bath says surgery or liposuction may rarely be necessary to remove the extra breast tissue.

Policies differ by area. Luton and Dunstable University Hospital says surgery is restricted on the NHS to highly selected cases; it is only possible if funding is approved, applied for by your GP, and requires a normal body weight, not taking any drugs that could cause gynaecomastia, and at least 200g of breast tissue needing to be removed. University Hospitals Sussex says surgical treatment is not available on the NHS in Brighton and Hove. Ask your GP what applies where you live.

The NHS says to see a GP if you are worried about the size of your breasts or how they look, have pain in your breast or nipple that is not going away, a lump in your breast or nipple, changes in the skin such as a rash, dimpling (which may look like orange peel) or redness, or discharge or bleeding from one or both nipples. The NHS says to try not to be embarrassed, as the doctor or nurse will be used to talking about these symptoms.

Royal United Hospitals Bath says breast cancer is very rare in males and feels different from the breast tissue of gynaecomastia, and may also cause skin dimpling or a bloody nipple discharge. Luton and Dunstable says that about 1 in 100 breast cancers are diagnosed in men and that this is not related to gynaecomastia.

Most people start with a GP, who can check medicines, weight and general health and arrange blood tests or a referral to a breast unit or endocrinology service. Many men are discharged back to their GP after a first clinic visit, as University Hospitals Sussex describes.

Surgery is the area where routes differ most. NHS funding is restricted in many areas, and some people choose private consultation and surgery. Whichever route, a check for any underlying cause comes first.