unilateral gynecomastia; discomfort levels

[riverrun]

Dear MD.

I was diagnosed with unilateral gynecomastia (left side) in late January of this year. At that visit I had a mammography and ultrasound. Cells were also drawn to test for cancer. That test came back negative.

In early March I returned as the swelling appeared to expand and the discomfort increased--though still very bearable and not requiring pain relievers, but enough to raise a concern, in my view. I had another mammography and ultrasound, which revealed minimal to no changes compared to the first round of tests in late January, but I was scheduled for a biopsy just to double check.

That biopsy was to be a few weeks ago, but the hospital had to divert personnel to deal with Covid-19 so it's been delayed. As a result, I have a few concerns/questions, if I may:

- is it possible for gynecomastia to now develop in the right breast too (i.e., they don't develop synchronously)? Sometimes I feel a tingling session in the vicinity of my right breast.

- how long does the physical discomfort last? (It's been a few months now; not serious pain that requires pain relievers, but the occasional pinch or feeling of tightness of skin around the left breast as if the skin is stretching; sensitivity to touching around the left nipple; very very occasional discomfort to the touch under what feels like a breast bone (for lack of a better term), like a bruised feeling that will come for a few hours or so and then disappear; when I stretch my arms back behind my back there is sometimes a feeling of tightness around the left breast, as if the skin is being unnaturally pulled).

Should this discomfort be ongoing for awhile? Will the breast (or breast tissue) continue to grow for another few months? In short, how long do people typically have to wait for these changes to stabilize? I some point I would like to consider surgery, and so I'm left wondering how long this discomfort will continue/when things will stabilize before I look into surgery.

Thanks kindly for your time.

[Miguel Delgado MD]

Riverrun,
Thank you for your question.

It would be helpful to know how old you and if you are currently taking any medications, including steroids or if you have in the past.  In addition, have you had any hormone tests performed?

Unilateral gynecomastia is more common than people realize and it is more prevalent on the left side.  If you are young, the radiological test is not usually very helpful but a good physical exam and health history are the most helpful information.  A biopsy will show breast tissue which we know already know exists. Breast cancer is extremely rare at a young age and is most common after age fifty.  I have successfully performed surgery on many men with unilateral gynecomastia. 

The treatment is male breast reduction surgery by Gynecomastia Experts.  In nearly 100% of cases, the pain goes away when the breast gland is removed.  You should have hormone testing.  I can further comment on your case if you share a photo. 

Here is a link to a case study that you might find helpful as you determine what is the best treatment path for you.  https://e-aaps.org/upload/pdf/aaps-23-101.pdf

Best of luck,

Miguel A. Delgado, Jr. M.D., FACS
www.dr-delgado.com
www.Gynecomastia-specialist.com
415-898-4161

[riverrun]

Greetings, Dr. Delgado.

Thank you for taking time out of your busy schedule to reply to my post. 

As per your request, I attached some photos here. Further, I am 46 years old. I have never taken steroids, am not taking any medication (and haven't for decades), and live a healthy lifestyle (exercise 5/7 days/week; 2-3 alcoholic drinks/month; eat well). I am 5'8" and weigh 162 lbs. If I may, how long is the evolving period and will the discomfort remain permanently without surgery? I am interested in surgery but am also wondering why this discomfort continues to persist (and seemingly increase) and if there is any value in waiting for the condition to fully evolve.

Thank you again for your time.

[Miguel Delgado MD]

Dear Riverrun,

The pain and discomfort you are experiencing is a result of your condition.  I can tell from your photo that you have a large mass of breast gland on your left side.  Surgery will resolve your issue and waiting is of no value especially at your age. I would still check for a normal hormone profile.   Because you present as a very healthy man with low body fat, your surgeon can be aggressive which will give you anaesthetic result.  

Best of luck with whatever you choose to do.

Miguel A. Delgado, Jr., M.D.
www.dr-delgado.com
www.Gynecomastia-specialist.com
415-898-4161
165 Rowland Way, Suite 300 Novato, CA
450 Sutter Street, Suite 2433 SF, CA

[riverrun]

Dear Dr. Delgado,

Just a quick thank you for your time and input. I will give your advice serious consideration.
Best wishes for a pleasant start to your week.

RR