Complications of Gynaecomastia
The complications of gynaecomastia are primarily psychological, but physical and clinical concerns can also arise in persistent or misdiagnosed cases. Although gynaecomastia is not a life-threatening condition, the complications of gynaecomastia can significantly affect quality of life, especially when symptoms are severe, long-standing, or overlooked.
Understanding these potential consequences is essential for clinicians and patients alike to guide management decisions and avoid unnecessary distress.
1. Psychological and Social Complications
Perhaps the most common — and often underestimated — complications are emotional in nature. Men and boys with gynaecomastia frequently report:
Embarrassment and shame, especially in public changing areas
Body image dissatisfaction, often leading to social withdrawal
Bullying or teasing, particularly during adolescence
Avoidance of activities like swimming, sport, or intimacy
Depression, anxiety, or social phobia
These psychological effects may persist long after the physical condition resolves and can interfere with education, relationships, and personal development.
2. Chronic Pain or Tenderness
Some individuals experience:
Persistent breast pain or sensitivity
Discomfort when lying on the chest or wearing fitted clothing
Nipple tenderness or itching
This is more common when gynaecomastia is due to hormone fluctuations or medications, and may fluctuate in severity. Pain can disrupt sleep, concentration, or exercise routines, adding to emotional strain.
3. Skin and Tissue Changes
Long-standing or significant breast enlargement can lead to:
Stretching of skin and areolae
Sagging or drooping (ptosis) of the breast tissue
Excess skin that may remain even after weight loss or regression
These cosmetic issues may persist even if the underlying glandular tissue shrinks, prompting some men to seek surgical correction.
4. Surgical Complications (When Applicable)
Although surgery is generally safe, as with any procedure, risks include:
Bleeding or haematoma formation
Infection
Scarring, including hypertrophic or keloid scars
Asymmetry or contour irregularities
Changes in nipple sensation (temporary or permanent)
Complications can be minimised by choosing a qualified surgeon, following postoperative instructions, and attending follow-up visits.
5. Medication Side Effects
For those using pharmacological treatments like tamoxifen or aromatase inhibitors:
Side effects may include fatigue, hot flushes, headaches, or libido changes
Long-term safety of off-label medications is still under study
Monitoring and communication with a healthcare provider are essential
Discontinuation of therapy due to side effects may also lead to a return of symptoms, particularly if the underlying cause is not addressed.
6. Missed or Delayed Diagnosis of Serious Conditions
One of the most important complications is the potential for missed diagnosis of an underlying issue:
Testicular tumours or adrenal tumours that secrete oestrogens
Chronic liver disease, which alters hormone metabolism
Kidney failure or thyroid disorders
Rare cases of male breast cancer
Assuming all gynaecomastia is benign can delay detection of these serious diseases. Red flags that require further investigation include:
Unilateral breast enlargement
Hard, fixed lumps
Nipple discharge or skin dimpling
Lymph node swelling
Proper diagnostic work-up, including imaging and hormonal testing, is crucial when atypical features are present.
7. Reduced Physical Performance or Activity
In athletes or those with active lifestyles, gynaecomastia can:
Interfere with upper body movements due to discomfort
Cause self-consciousness during team sports
Lead to avoidance of gym or outdoor activities
These issues can contribute to decreased fitness, which may further affect confidence and hormone regulation.
8. Ongoing Recurrence After Resolution
In some cases:
Gynaecomastia recurs even after initial resolution
May follow a return to causative medications or substance use
Hormonal imbalances may fluctuate, especially in older adults or those with underlying endocrine conditions
This can create a cycle of repeated distress and treatment attempts, especially if the underlying trigger is not addressed fully.
Conclusion | Complications of Gynaecomastia
The complications of gynaecomastia extend beyond physical symptoms, encompassing a wide range of emotional, psychological, and medical challenges. While most cases are benign and treatable, untreated or misdiagnosed gynaecomastia can significantly impact quality of life. By recognising and addressing the complications of gynaecomastia, healthcare professionals can provide holistic care that prioritises both physical outcomes and emotional wellbeing.
