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Unilateral Gynecomastia or “One-Sided” Gynecomastia

Gynecomastia is a common condition affecting Up to 60% of adolescent males. It typically presents as two-sided or “bilateral” growth which may or may not be symmetric Although less common than bilateral gynecomastia, unilateral gynecomastia affects 5-10 % of all men and about 25% of all gynecomastia. This condition can occur at any age but is more prevalent during adolescence.

Like bilateral gynecomastia, unilateral gynecomastia is a benign condition that is no different in terms of diagnosis and treatment. Unilateral gynecomastia is harder for men to deal with compared to the symmetrical or bilateral, regardless of the type of gynecomastia. While both forms of gynecomastia can bring about feelings of shame, distress, and confusion, having only one enlarged breast makes the condition highly visible, which may lead to additional psychological harm to patients. Certain medications that contribute to the development of gynecomastia may even affect the symmetry of the condition.

At the Boston Gynecomastia Specialists, we are here to help you better understand your condition and treatment options to get you going in the right direction. We invite you to schedule an individualized in-person consultation and take the first step.

Diagnosis of Unilateral Gynecomastia

The diagnosis of one-sided gynecomastia is performed by visual inspection. The clinical appearance of unilateral gynecomastia varies considerably. The gynecomastia can either be large or small in size and can appear very similar in appearance to a true female breast. For unknown reasons, it is more common to develop on the left side of the chest. It may or may not be associated with tenderness, which usually persists for only a short period of time unless you are taking medications that are causing inflammation of the tissue. The actual gynecomastia tissue itself is more commonly glandular – rather than the fibrous variety – for unknown reasons.

Benign masses, cysts and abscesses can also occur on only one side of the chest and are usually easy to diagnose by an experienced clinician. These are treated by surgical removal of the benign mass or incision and drainage of the abscess.

Special studies or radiological tests are not necessary unless your doctor suspects the possibility of breast cancer, in which case the work up is usually the same as it is for female patients – mammography, other radiology studies or even a biopsy. Again, this is quite rare and for most guys reading this information there is absolutely nothing to worry about. Unfortunately, many patients end up having a full work up for breast cancer when it clearly was not indicated. In fact, “cancer phobia” is one of the common psychological consequences of unilateral gynecomastia and reassurance is what is needed. There is no need to panic, especially if you have been searching with “Dr Google.” If you want assurances, you need to seek out the expertise of a doctor who is knowledgeable and experienced with gynecomastia.

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Risk Factors / Causes of Unilateral Gynecomastia

It is unknown why some men develop unilateral gynecomastia. Most cases of bilateral gynecomastia result from pubertal development or hormone use and persist well into adulthood. Unlike asymmetric Gynecomastia, this condition is not solely affected by genes and can affect anyone suffering from a variety of risk factors as outlined below:

  • Hormonal Imbalance: Fluctuations in hormones, especially increased estrogen relative to testosterone, can cause unilateral gynecomastia. This can occur during puberty, ageing, or due to conditions like hypogonadism or hyperthyroidism.
  • Medications: Some studies have shown unilateral gynecomastia associated with various drugs. For instance, oral Finasteride or “Propecia” used to treat male androgenic alopecia or male pattern baldness, anti-androgens (used to treat prostate cancer), anabolic steroids, certain antidepressants, antipsychotics, anti-anxiety medications, and heart medications, among others. Illicit drugs like marijuana, heroin, and certain types of steroids can lead to asymmetric gynecomastia by interfering with hormone levels or estrogen metabolism. In cases of unilateral gynecomastia, the tissue on one side of the chest may be more sensitive to the effects of these medications, resulting in asymmetrical breast enlargement.
  • Health Conditions: Liver disease, kidney failure, hyperthyroidism, and tumors that affect hormone levels (such as testicular, adrenal, or pituitary glands) can all lead to hormonal imbalances that trigger unilateral gynecomastia in some cases.
  • Genetics: A family history of gynecomastia can indicate a genetic predisposition to developing the condition.
  • Lifestyle Factors: Excessive alcohol consumption and illicit drug use can contribute to hormonal imbalances, raising the risk of one sided gynecomastia.
  • Obesity: Excess body fat elevates estrogen production, which can cause unilateral gynecomastia. Up to 70% of adolescent boys with gynecomastia are overweight or obese.

Surgical Treatment of Unilateral Gynecomastia in Boston

Contrary to what you may think, the best treatment for unilateral gynecomastia is treatment on BOTH sides. I have learned that it is essential to treat both sides so that the result is smooth and symmetrical. There is usually some fullness on the smaller side that benefits from treatment so both sides look the same. If not, the smaller side will appear like it has gynecomastia after treatment! At the Boston Gynecomastia Specialists, the treatment of choice for almost all patients is the use of VASER™ Ultrasonic liposuction to shrink the actual fatty tissue, followed by the use of cannula liposuction to remove the “loosened” fat and contour the shape of the chest. A small incision is made at the areola border to remove the enlarged breast tissue.

In addition to correcting the difference between breast sizes, the areola often shrinks when gynecomastia excision is performed. In more pronounced cases, the areola may even be more prominent. When the glandular tissue is removed, the areola symmetry may improve.

Unilateral Gynecomastia surgery is designed to correct asymmetry where only one breast has excess glandular tissue, commonly referred to as male breast reduction. Usually lasting one to two hours. The steps involved include:

  1. Anesthesia: Administration of local anesthesia to ensure chest numbness and comfort during the procedure.
  2. Liposuction: Utilization of techniques to remove excess fatty tissues, if present and to better contour the chest.
  3. Tissue Excision: Removal of glandular tissue on both sides to establish chest symmetry and illuminate the risk of recurrence.
  4. Nipple-Areolar Complex (NAC) Contouring: Excising small rim of areola or excess skin to elevate or reposition the NAC as necessary for each patient.

Each surgery is tailored to the patient’s specific needs, utilizing either liposuction, excision, or a combination.

Recovery time varies, but patients typically resume normal activities within a week and more strenuous ones after a few weeks. Possible side effects include swelling, bruising, and discomfort. Tips for a smooth recovery include:

  • Wearing compression garments as advised
  • Avoiding strenuous activities until cleared by the surgeon.
  • Keeping the chest area protected from excessive force or motion.
  • Attending all scheduled follow-up appointments with the surgeon

If you are struggling with unilateral gynecomastia and are considering surgery, it is crucial to choose a skilled and experienced surgeon who specializes in gynecomastia surgery. At Boston Gynecomastia Specialists, we understand the physical and emotional impact of unilateral gynecomastia and are committed to helping our patients achieve their desired results.

Our highly recommended cosmetic surgeon in Boston, Dr. Edwin Ishoo, has decades of experience in performing male breast reduction surgeries, including the treatment of unilateral gynecomastia. We take a personalized approach to each case, ensuring that every patient receives the highest level of care and attention.

Unilateral Gynecomastia FAQs

In many cases, unilateral gynecomastia resolves without treatment, especially during puberty. However, if it persists into adulthood, medical intervention may be necessary.

Untreated unilateral gynecomastia may lead to persistent breast enlargement, psychological distress, and self-esteem issues, impacting overall quality of life.

You can prevent unilateral gynecomastia by:

  • Maintaining a healthy weight
  • Exercising regularly
  • Avoiding hormonal disruptors (certain drugs)
  • Limiting alcohol consumption

The treatment for unilateral gynecomastia depends on the severity of the condition, the underlying cause, and the patient’s overall health and preferences.

In many cases, the condition may resolve on its own. This is particularly true if this condition occurs during puberty. However, if the condition persists or causes significant distress, treatment options are available.

  • Observation And Lifestyle Changes: In mild cases of unilateral gynecomastia, where the enlargement is not causing significant physical or emotional distress, a “watchful waiting” approach may be recommended. This involves monitoring the condition over time. This is done to check if the condition betters or resolves on its own. Additionally, lifestyle changes such as maintaining a healthy diet, avoiding drugs and alcohol, and discontinuing any medications that may be contributing to the condition can be beneficial.
  • Medical Treatment: If an underlying hormonal imbalance is identified as the cause of unilateral gynecomastia, hormone therapy may be prescribed to restore balance and reduce breast tissue growth. Medications such as selective estrogen receptor modulators (SERMs) and aromatase inhibitors can be effective in some cases. However, these treatments are generally more effective when started early and may not be suitable for all patients.
  • Surgical Treatment: For men with persistent or severe unilateral gynecomastia, surgery is often the most effective treatment option with surgical removal of both glands and if necessary, contouring of chest with liposuction.

Recovery from unilateral gynecomastia surgery involves:
• wearing compression garments
• managing discomfort with prescribed pain medications
• following post-operative instructions provided by your surgeon.

While recurrence is rare, unilateral gynecomastia may return if the underlying cause is not adequately addressed such as treatment with liposuction alone or incomplete resection of the gland, or if new hormonal imbalances occur.

A more serious cause of unilateral gynecomastia is male breast cancer. This is uncommon compared to cancer of the female breast and makes up less than 1% of all breast cancer diagnoses. Male breast cancer presents itself differently than gynecomastia, is typically clinically obvious and not challenging to diagnose. It is usually described as a firm mass that has been present for quite some time that may be stuck to the surrounding tissue. It is non-tender and may be associated with changes in the overlying skin, enlarged lymph nodes in the arm pit, drainage from the nipple itself and can cause ulceration of the skin in advanced cases. It occurs in older males and the average age at diagnosis is 67.

Risk factors for breast cancer in men include:

  • increasing age
  • race
  • family history of breast cancer

Increased levels of female sex hormones, obesity and gynecomastia are also associated with male breast cancer. Klinefelter’s syndrome (XXY) has been associated with a higher rate of breast cancer, as much as 50 times the average according to one study.

Seek The Expert in Treating Unilateral Gynecomastia

In summary, unilateral gynecomastia may make up a small portion of all of gynecomastia cases; but it can be a challenging condition to live with. Fortunately, it is treatable. and is no different in diagnosis and approach when compared to bilateral gynecomastia. Treatment is usually bilateral, and when performed by an expert, the results will be a more masculine appearing and symmetric chest and liberation from both the mental and physical burden of gynecomastia.

If you are wondering if you have unilateral gynecomastia or about our treatment, contact Boston Gynecomastia Specialists today and submit our online intake form including photo of your chest through our online initial intake form to schedule your consultation with Dr. Ishoo. and take the first step toward a more confident and comfortable life.

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The Boston Gynecomastia Specialists is the premier Greater Boston Gynecomastia Center of Excellence. Our primary focus is on providing outstanding care throughout every step of your journey, from the first consultation to your full recovery. We recognize and appreciate the confidence you have in us and are unwavering in our commitment to maintaining the utmost level of patient care. Led by Dr. Edwin Ishoo, a highly skilled, board-certified surgeon with expertise and over 30 years’ experience in Male Breast Reduction, our dedicated team is fully committed to ensuring the best possible surgical outcomes tailored for each individual. Recognizing that every man is unique, we personalize our approach to meet your specific condition, needs and expectations. We welcome you to take that first step to achieving the transformation you have been imagining and contact the Boston Gynecomastia Specialists, the leading Gynecomastia Center in Boston, to meet with Dr. Ishoo for your personalized, in-person consultation and have your questions answered. Let us take the gynecomastia concern off your chest in a day and off your mind forever!

Boston Gynecomastia Specialists
1260 Cambridge st
Cambridge, MA 02139
(888) 380-3222