Lipomastia is an excessive deposition of fat in the chest in men. It is manifested by an increase in the volume of the mammary glands, a displacement of the nipple and areola downwards. There are no subjective complaints. Breast ultrasound and laboratory research methods are used in the diagnosis. To correct the disorder, it is usually enough to reduce the calorie content of the diet and increase physical activity. With a significant severity of fat deposits, drugs are prescribed that accelerate metabolism and reduce the absorption of fat in the intestine. In extreme cases and with the patient’s insistent desire, surgical treatment (liposuction, mastopexy) is used.
Lipomastia (false, or fatty, gynecomastia, pseudohynecomastia) is a fairly common manifestation of disorders of fat metabolism, which does not pose a threat to a man’s health, but can contribute to psychological problems. Such fat deposition occurs in men of different ages, from teenagers to the elderly. “Pure” lipomastia is observed mainly in patients aged 20-50 years, while at puberty and involution, pathology is usually combined with signs of gynecomastia. The importance of correct diagnosis with breast enlargement in men is due to the presence of quite serious somatic diseases and endocrinopathies among the provoking factors.
Excessive accumulation of fat in the mammary glands in men usually leads to general obesity, in which there is a proportional change in the volume of other parts of the body — in the abdomen, thighs. Extremely rarely, such fat deposition is detected in patients with normal or reduced weight. Predisposing factors to the development of obesity with lipomastia are:
- Hereditary predisposition. The constitutionally exogenous type of obesity often occurs against the background of genetically determined leptin deficiency. In such patients, the receptors of the hypothalamic-pituitary region are less sensitive to the hormone leptin, which regulates fat metabolism.
- High-calorie diet. Excess calories coming from food are accumulated by the body in fat depots. The increase in calories is absolute, arising from the consumption of large amounts of high-calorie foods, and relative, which is more often caused by low motor activity.
- Alcohol abuse. With an extremely low nutritional value, alcohol has a high calorie content. Alcohol consumption leads to a violation of the utilization of estrogens in the liver and the accumulation of fat according to the “female” type. The situation is aggravated in patients who abuse beer, which contains phytoestrogens.
- Hormonal disorders. Fat metabolism is disrupted in some diseases of the adrenal glands, pancreas and thyroid glands, the use of hormonal drugs, primarily corticosteroids. An imbalance of hormones slows down the basic metabolism and contributes to the deposition of excess fat.
In a number of men, lipomastia is combined with gynecomastia. Such disorders are usually caused by an imbalance of sex hormones, which is observed in adolescent boys during puberty and in patients over 50 years of age during the extinction of the endocrine function of the testicles. The excess of estrogens in these patients provokes the proliferation of both adipose and glandular tissue of the mammary glands.
According to research in the field of mammology, the key link in the pathogenesis of lipomastia is an increase in the volume, and in some patients, the number of fat cells in the places of fat deposition. An additional factor is the relative increase in the level of estrogens that occurs in such men due to the action of the aromatase enzyme, which is contained in adipose tissue and is responsible for the conversion of testosterone into estrogen. The increased concentration of female sex hormones leads to a specific gynoid distribution of fat with predominant accumulation in the hips, buttocks and mammary glands.
Excess adipose tissue in the breast is not accompanied by any painful sensations and is an aesthetic defect. Visually, the mammary glands are enlarged in size, painless to the touch, soft, without seals. The increase can be either small, localized in the nipple area, or significant, noticeable even under clothing. The nipple-areolar complex with pronounced lipomastia is often shifted downwards, but the nipple has the usual size and color, there is no increase in areola pigmentation. There is no discharge from the nipple when pressing on the breast. Usually such disorders are bilateral and are accompanied by signs of obesity (increased weight, fat deposits in other areas).
As a cosmetic defect, lipomastia does not pose any risk to a man’s health. However, in some cases it contributes to the emergence of emotional disorders. The destruction of a holistic image of oneself as a male representative causes shame, shyness and uncertainty, reduces self-esteem. This can provoke the development of neurotic states with a tendency to a subdepressive response and lead to a deterioration in the patient’s quality of life. In the most serious cases of lipomastia, anorexia nervosa, dysmorphic phobia, depression with suicidal thoughts, anxiety, hypochondria, carcinophobia are possible.
The correctness of the diagnosis in men with enlarged breasts affects the choice of optimal medical tactics. The main objectives of the diagnostic examination for suspected lipomastia are the exclusion of pathological changes in the mammary glands and the identification of the causes that led to the proliferation of adipose tissue. Usually in such cases it is recommended:
- Breast ultrasound. Mammary glands are characterized by reduced echogenicity, there are no focal changes. Parenchymal tissue is not detected. Regional lymph nodes are not changed.
- Determination of the level of sex hormones. The content of free and bound testosterone, estradiol is usually not changed. A number of patients have relative hyperestrogenism.
To clarify the causes that contributed to the development of lipomastia, if necessary, liver functions (concentration of bilirubin and its fractions, ALT, AST, etc.), thyroid and pancreas, adrenal glands are examined. If true or mixed gynecomastia or breast cancer is suspected, mammography, puncture biopsy of the breast with cytological examination of the obtained material is performed. In doubtful cases, the patient is consulted by an endocrinologist, oncologist, urologist, gastroenterologist, plastic surgeon, psychiatrist.
Usually, the amount of fat deposits in the breast area decreases with weight loss, so men with lipomastia are recommended to change their diet and increase motor loads. Patients with severe obesity may need to consult a nutritionist and a physical therapy doctor. With a significant increase in the mammary glands and the occurrence of psychological discomfort , use:
- Correctors of metabolism. With lipomastia, the means to increase the basal metabolism and reduce the absorption of fats are effective. Such drugs can reduce fat deposits in the subcutaneous tissue and accelerate its burning.
- Surgical methods. Laser or conventional liposuction is recommended to remove soft fat in the absence of coarse connective tissue partitions. In other cases, liposuction is combined with mastopexy (breast skin tightening).
Prognosis and prevention
The prognosis is favorable. Normalization of weight allows you to get rid of the signs of lipomastia or significantly reduce their manifestations. After surgical removal of excess fat, relapses are possible only if the provoking factors continue to act. For preventive purposes, motor activity, rational nutrition with the use of sufficient amounts of vegetables and fruits, restriction of fatty and sweet foods, and refusal to abuse alcoholic beverages are recommended. When detecting diseases that contribute to the development of lipomastia, it is necessary to be regularly examined by a specialized specialist and take supportive treatment.
- Braunstein G.D. Clinical practice. Gynecomastia // N Engl J Med. — 2007; 357(12): 1229-37. link
- Thompson D.F., Carter J.R. Drug-induced gynecomastia // Pharmacotherapy. — 1993; 13(1): 37-45. link
- Carlson H.E., Kane P., Lei Z.M., Li X., Rao C.V. Presence of luteinizing hormone/human chorionic gonadotropin receptors in male breast tissues // J Clin Endocrinol Metab. — 2004; 89(8): 4119-23. link
- Bird J., Li X., Lei Z.M., et al. Luteinizing hormone and human chorionic gonadotropin decrease type 25 alpha-reductase and androgen receptor protein levels in women’s skin // J Clin Endocrinol Metab. — 1998; 83(5): 1776-82. link
- Gill S., Peston D., Vonderhaar B.K., Shousha S. Expression of prolactin receptors in normal, benign, and malignant breast tissue: an immunohistological study // J Clin Pathol. — 2001; 54(12): 956-60. link