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Breast enlargement: physiologic and pathologic

Medical expert of the article

Mammologist, surgeon
, medical expert
Last reviewed: 04.07.2025

Endocrinologists divide breast enlargement into physiological and pathological. In the first case, we are talking about a natural process, in the second - about a disease associated with hormonal imbalance. The mammary glands - their size, structure and features of functioning - are in direct or indirect dependence on the production of a whole group of hormones by the body: estrogen, estradiol, progesterone, prolactin, hormones of the pituitary gland, hypothalamus, adrenal cortex, thyroid and pancreas.

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Causes breast enlargement

Physiological, that is, natural reasons for the enlargement of mammary glands in women of reproductive age are cyclical in nature, associated with menstruation. During pregnancy and breastfeeding, a complete hormonal restructuring of the body occurs, which also affects the mammary glands. And in girls, the growth of mammary glands continues throughout the entire period of puberty.

All other cases of breast enlargement in women and men are usually caused by pathology or abnormalities in the hormonal sphere. Pathological hypertrophy of the mammary glands can develop due to the proliferation of connective tissue, and in women with excess body weight - due to the deposition of fatty tissue. Temporary enlargement of the mammary glands is possible during recovery from serious illnesses that caused significant weight loss.

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Where does it hurt?

Forms

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Breast enlargement in women

Enlargement of the mammary glands before menstruation (mastodynia or mastalgia) is noted by most women. Steroid hormones are also directly involved in this: during the next maturation of the follicle, their release into the blood increases. Estradiol produced by the ovaries promotes the growth of connective fibers and the enlargement of the ducts of the mammary gland. And progesterone, which is produced by the corpus luteum and the adrenal cortex, causes an increase in the number of glandular cells in the woman's mammary glands. This process is reversible, and with the end of menstruation, everything returns to its original state.

Breast enlargement may occur in women who use hormonal contraception or take medications containing certain types of hormones.

However, enlargement and pain in the mammary glands can be a symptom of a disease such as diffuse mastopathy. In this case, the pain in the chest is longer and more intense than before menstruation, and can spread to the armpit, shoulder and shoulder blade. As doctors note, patients complain of acute pain in the chest when moving and touching. In this case, a mandatory symptom is minor tissue compaction detected during palpation (mainly in the upper part of the gland, towards the armpit). If these signs are present, you must immediately contact a gynecologist or mammologist who will conduct an examination and prescribe treatment.

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Breast enlargement during pregnancy

The process of breast enlargement during pregnancy is the preparation of the woman's body for breastfeeding, that is, for the secretory activity prescribed by nature itself. In this process, the main role is played by hormones such as estrogen, progesterone, prolactin and placental lactogen (placental somatomammotropin). The last hormone is special, since it is produced only during pregnancy - by the placenta.

Many changes occur in the mammary glands of a pregnant woman: the volume of glandular tissue (which produces milk) increases, the alveoli grow in the milk lobes, the excretory ducts expand, and the number of milk ducts increases.

The enlargement of the mammary glands during pregnancy continues almost throughout the entire period of bearing a child, although the breasts of the expectant mother are ready to produce milk already by the 4th-5th month of gestation.

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Enlargement of the mammary glands in men

Despite the fact that the mammary glands in men are rudimentary organs, a problem can also arise with them. This is gynecomastia - a benign enlargement of the mammary glands in men, exceeding 2 cm in diameter. In clinical medicine, gynecomastia is not considered an independent disease, but is considered a sign of other pathologies.

The main reasons for breast enlargement in men are the following:

  • use of certain pharmacological drugs (estrogens, cardiac glycosides, phenothiazines, tricyclic antidepressants, etc.);
  • insufficient production of the main male sex hormone testosterone;
  • decreased androgen production (hypogonadism);
  • hypercorticism syndrome (Itsenko-Cushing syndrome with chronic excess of adrenal cortex hormones in the body);
  • tumors of the adrenal glands, testicles, or pituitary gland;
  • hyperthyroidism (hyperfunction of the thyroid gland);
  • acromegaly (disproportion of bone growth due to excessive production of the growth hormone somatotropin);
  • alcoholic cirrhosis of the liver;
  • chronic renal failure (with imbalance of estrogens and androgens);
  • shingles (Herpes zoster) in the chest area;
  • obesity (pseudogynecomastia).

As can be seen from the list above, in most cases, breast enlargement in men is also associated with hormonal changes. Gynecomastia can affect one or both breasts, and in eight out of ten cases, bilateral proliferation of glandular tissue is observed.

Breast enlargement in a child

An increase in the mammary gland in a child in the neonatal period looks like swelling of the chest and should not cause concern. This is observed quite often - both in girls (more than 80%) and in some boys.

In pediatrics, this physiological phenomenon is called an infantile hormonal crisis, which occurs as a result of maternal estrogens entering the baby's blood through the placenta. Due to increased secretion of pituitary hormones, colostrum may be secreted from the newborn's nipples.

As a rule, by the end of the first month of a newborn's life, breast swelling disappears on its own. In 2% of infants, breast enlargement persists for 3-6 months, in some cases up to 10 months.

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Breast enlargement in girls

Physiological enlargement of the mammary glands in girls begins at 8-11 years of age, pathological enlargement can be observed at an earlier age - up to 8 years.

This pathology in girls is explained by the syndrome of premature puberty, which can manifest itself as a result of a violation of gonadotropic regulation, ovarian cysts or tumors, congenital hypothyroidism, and germ cell tumors. In addition, pathological enlargement of the mammary glands in girls can be the result of a congenital mutation of the gene responsible for the synthesis of estrogens in the body, or the use of hormone-containing drugs.

At the same time, the physical development of girls with this pathology corresponds to age norms, but the maturation of the skeletal system (bone age) can be 1.5-2 years ahead of their peers.

Enlargement of the mammary glands in boys

Pubertal or juvenile gynecomastia is an enlargement of the mammary glands in boys aged 11 to 15 years, that is, during puberty. According to endocrinologists, this pathology manifests itself as a slight swelling of the areola (in the form of a nodule) and some hypersensitivity of the nipples and is detected in almost half of absolutely healthy boys.

The reason for the enlargement of the mammary glands in boys has not yet been fully clarified, but there is every reason to believe that it is associated with a temporary hormonal imbalance. During this period, the production of the gonadotropic hormone follitropin by the anterior pituitary gland increases, while the ratio of the male hormone testosterone and the female hormone estrogen in the growing body is disrupted.

After puberty, the mammary glands in young men return to normal.

Diagnostics breast enlargement

In the diagnosis of pathological enlargement of the mammary glands in women the following are used:

  • collection of anamnesis (including family history on the female side);
  • visual examination to determine the amount of glandular tissue in the mammary glands;
  • mammography;
  • Ultrasound of the mammary glands;
  • radioisotope scanning of the mammary glands;
  • lymphography and phlebography;
  • laboratory blood tests for hormonal status - chemiluminescent immunoassay (CLIA) and enzyme-linked immunosorbent assay (ELISA).

Diagnosis of breast enlargement in men is carried out using methods such as:

  • blood test for levels of testosterone, estradiol, adrenocorticotropic hormone and cortisol, thyrotropin, human chorionic gonadotropin, etc.;
  • urine test for levels of nitrogen, urea, creatinine and liver transaminases;
  • lung x-ray;
  • CT scan of the brain and adrenal glands;
  • MRI (to detect pituitary adenoma).

Diagnosis of pathological enlargement of the mammary glands in a child includes:

  • detailed medical history, physical examination;
  • blood test to determine the level of hormones: estradiol, prolactin, testosterone, luteotropin (LH), follicle-stimulating hormone (FSH), 17-hydroxyprogesterone (17-OPG), and dehydroepiandrosterone sulfate (DHEA-S). The analysis data allows to confirm or exclude premature sexual development of the child or congenital dysfunction of the adrenal cortex;
  • blood test for markers of germ cell tumors (if the presence of a germ cell tumor is suspected);
  • X-ray of the hands and wrist joint (to determine bone age);
  • Ultrasound of the mammary glands, pelvic organs, adrenal glands and thyroid gland;
  • CT and MRI of the brain and adrenal glands.

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Treatment breast enlargement

Therapy for these pathologies involves addressing the causes that led to their occurrence. Therefore, treatment is aimed at the underlying disease and is determined individually for each patient.

In case of breast enlargement before menstruation, it may be recommended to take non-steroidal anti-inflammatory drugs and diuretics. Non-steroidal anti-inflammatory drugs help with the pain that many women experience during menstruation. Most often, doctors recommend taking Ibuprofen (other trade names are Ibuprom, Ibufen, Imet, Nurofen, Solpaflex, etc.) - one tablet (200 mg) three times a day. This medicine is contraindicated in case of exacerbation of stomach ulcers and ulcerative colitis, disorders of hematopoiesis, kidney and liver function. Possible side effects include nausea, flatulence, constipation or diarrhea, dizziness, insomnia, and skin rash.

In case of breast enlargement before menstruation due to swelling of breast tissue, a diuretic such as Veroshpiron (analogues of Aldactone, Spironolactone, Verospirone, Spironol) can help, which cannot be used in acute renal failure. Tablets of 0.025 g are taken orally one piece 3-4 times a day. Possible side effects include dizziness, drowsiness, dermatoses, decreased sodium levels in the blood and increased potassium levels.

In case of significant breast enlargement and soreness during the premenstrual period, the doctor may prescribe the local gestagenic drug Progestogel, which contains the corpus luteum hormone progesterone. The product is available as a 1% gel (in a tube with a spatula-dispenser). The gel is applied to the skin of the mammary glands (with rubbing) twice a day. The duration of the course of treatment is determined by the doctor. To date, side effects of this drug have not been identified, and individual hypersensitivity is a contraindication to its use.

Treatment of breast enlargement in men

The specifics of treating breast enlargement in men (gynecomastia) also include eliminating the underlying cause, for which hormonal drugs are used. For male gynecomastia, the ergot drug Bromocriptine (Bromocriptine, Pravidel, Parlodel) may be prescribed. This drug is intended to suppress lactation, since it inhibits the production of hormones of the anterior pituitary gland - prolactin and somatotropin. For male prolactin-dependent hypogonadism, including enlarged breasts, this drug is taken 1.25 mg three times a day - after meals. Treatment can last from one month to six months.

Bromocriptine has side effects that include dizziness, headache, nausea and vomiting, as well as weakness, pale skin and drowsiness. This drug is contraindicated for patients under 15 years of age, with high blood pressure, ischemic heart disease, decompensated cardiovascular diseases and gastrointestinal pathologies.

Clomiphene (analogues of Clomid, Klostilbegit, Serofen, Serpafar) used for androgen deficiency is a non-steroidal anti-estrogen that affects the pituitary gland's estrogen receptors. The drug is not prescribed for renal dysfunction and liver failure, genital tumors, pituitary dysfunction, and a tendency to form blood clots. Its contraindications include: dizziness and headache, drowsiness and slow reactions, nausea and vomiting, stomach pain, flatulence, alopecia (baldness). Clomiphene is prescribed to men at 50 mg 1-2 times a day.

In the treatment of breast enlargement in adult men, the use of male sex hormones is rarely practiced, since the same testosterone provokes gynecomastia: it activates the adrenal enzyme arotamase, which converts testosterone into estrogen. However, intramuscular injections of testosterone can reduce the size of hypertrophied male breasts in the case of decreased androgen production (hypogonadism). For example, the drug Sustanon-250 (analogues of Omnadren 250, Testenate), which contains esters of this hormone, increases the level of testosterone in the blood. It is injected deep into the muscle in an amount of 1 ml - once every three weeks.

If the results of hormonal therapy are negative, men resort to surgical intervention to remove the affected mammary gland.

Treatment of breast enlargement in girls and boys

In case of premature breast enlargement in girls, drug treatment is not used. Doctor's observation and examination (once a year) are recommended. It is also necessary to temporarily refrain from any vaccinations.

As a rule, breast enlargement in boys does not require treatment. But if juvenile gynecomastia is significant and does not go away on its own for two or more years, it may be recommended to apply a tight bandage to the chest and, taking into account the patient's hormonal status, take hormonal drugs. Most often, a drug that reduces the function of the sex glands is offered (only as prescribed by an endocrinologist) - Danazol (synonyms Danoval, Bonzol, Danocrine, Danogar, Danol, etc.), which is available in capsules of 100 and 200 mg. The dosage for adults is 200-800 mg per day - in three doses; for adolescents - from 100 to 400 mg per day. The drug can cause side effects, which are nausea, dizziness, headache, complete or partial hair loss, acne on the skin, edema. This remedy for the treatment of breast enlargement is contraindicated in porphyria, and in the presence of cardiac and renal failure and diabetes mellitus it is prescribed with caution.

If drug therapy for juvenile gynecomastia is ineffective, subcutaneous mastectomy may be performed. In cases of extensive proliferation of fatty tissue, liposuction is used.

Prevention

In the vast majority of cases, prevention of breast enlargement is impossible, since the production of sex hormones, hormones of the thyroid and pancreas, hypothalamus, pituitary gland and adrenal cortex is determined genetically.

However, it should be borne in mind that a healthy lifestyle - rational nutrition and physical exercise - partly helps prevent hormonal imbalances. Thus, regular exercise, including strength training, can increase testosterone synthesis in men. But stress increases the level of cortisol, which can convert testosterone into estrogen.

You should be careful with food products rich in phytoestrogens. These include soy and lentils, nuts and sunflower seeds, oats and millet, cheese and beer. About beer. Hops, used in the production of this drink, contain a plant hormone similar to estrogen - a female steroid hormone. So immoderate beer consumption is fraught with hormonal imbalance in men.

Enlargement of the mammary gland, uncharacteristic of the physiological state, gender or age is a clear sign of disease. To find out the specific cause of the pathology and eliminate it, you should contact a medical institution. And doctors have the means to solve this problem in their arsenal.

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Forecast

The prognosis for breast enlargement is positive, although hormonal imbalance can trigger the development of other pathological processes in the body.

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