Gynecomastia

Gynecomastia
Classification and external resources
ICD-10	N62.
ICD-9	611.1
DiseasesDB	19601
MedlinePlus	003165
eMedicine	med/934

Gynecomastia, pronounced /ˌɡaɪnɨkɵˈmæstiə/, is the development of abnormally large mammary glands in males resulting in breast enlargement. The term comes from the Greek γυνή gyne (stem gynaik-) meaning "woman" and μαστός mastos meaning "breast". The condition can occur physiologically in neonates (due to female hormones from the mother), in adolescence, and in the elderly. In adolescent boys the condition is often a source of distress, but for the large majority of boys whose pubescent gynecomastia is not due to obesity, the breast development shrinks or disappears within a couple of years.^[1] The causes of common gynecomastia remain uncertain, although it has generally been attributed to an imbalance of sex hormones or the tissue responsiveness to them; a root cause is rarely determined for individual cases. Breast prominence can result from hypertrophy of breast tissue, chest adipose tissue (fat) and skin, and is typically a combination. Breast prominence due solely to excessive adipose is often termed pseudogynecomastia^[2] or sometimes lipomastia.^[3]

Gynecomastia should be distinguished from work hypertrophy of the pectoralis muscles caused by exercise, e.g. swimming, bench press.

Classification

Puffy Nipples is among the most common forms of gynecomastia. This glandular tissue accumulation is concentrated under and typically confined to the areola, or can be slightly extended outside the areola forming a dome shaped appearance to the areola.

Pure Glandular. In bodybuilders this may be a result of the use of anabolic steroids.^[4] Due to excess testosterone levels from steroids, which is converted to estrogen, bodybuilders and other athletes are sometimes afflicted with gynecomastia in its purest form. Gynecomastia in lean men is usually only a breast tissue gland with little to no adipose tissue. Proper treatment of pure gynecomastia can be done only by excision of the breast tissue, which in the case of bodybuilders is by itself sufficient to achieve a flat nipple-areola complex. Liposuction is only rarely necessary.

Adolescent. Congenital or Hereditary Gynecomastia is typically evident by the ages of 9 to 18 in boys.^[5] Thirty percent to sixty percent of young boys suffer from large male breasts.^[6] As many as thirty percent may live with enlarged male breasts for the rest of their lives, but in other cases the gynecomastia will recede with age. However, severe forms of adolescent gynecomastia may require an intervention, in consultation with the patient, the parents, and child development professionals.

Adult. The most common form of gynecomastia. Gynecomastia in most adults is composed of glandular tissue but may contain varying quantities of adipose and fibrous tissue.^[7]

Pseudogynecomastia^[8] is composed not of glandular tissue, but of adipose tissue. It looks much like real gynecomastia but requires different treatment. Exercise and diet may be effective in combating pseudogynecomastia. Only if this regimen is unsuccessful should surgery be considered. This is generally the only type of gynecomastia which can be improved with liposuction, but excision may be indicated in some cases. This is also known as "false Gynecomastia" and is often attributed by obesity whereby insulin interacts with an excess of sugars or certain carbohydrates, namely those of which that have been processed.

Asymmetric/Unilateral. Unilateral gynecomastia occurs when only one breast is larger due to gynecomastia, the other breast is typically normal in both size and shape. Bilateral Asymmetry occurs when gynecomastia is present in both breasts, each to a different degree.

Severe gynecomastia is characterized by excess and/or saggy skin and severely enlarged breasts . This is itself determined in part by age^[9] , as older persons suffering from gynecomastia tend to have less skin elasticity and thus will have a greater abundance of excess skin related to gynecomastia. Experienced plastic surgeons will perform as much of the surgical treatment of severe gynecomastia as possible through an aereolar incision so as to avoid extensive scarring. However, some scarring may be unavoidable when treating extreme cases of gynecomastia.

An example of the wide distribution of patient's gynecomastia effects is displayed below.

Puffy nipples	Pubertal onset gynecomastia	Pseudogynecomastia[10]	Asymmetric gynecomastia
AAS induced gynecomastia[11]	Severe Gynecomastia

Treatment

Treating the underlying cause of the gynecomastia may lead to improvement in the condition. Patients should talk with their doctor about revising any medications, such as risperdal, that are found to be causing gynecomastia; often, an alternative medication can be found that avoids gynecomastia side-effects, while still treating the primary condition for which the original medication was found not to be suitable due to causing gynecomastia side-effects (e.g., in place of taking spironolactone the alternative eplerenone can be used). Selective estrogen receptor modulator medications, such as tamoxifen and clomiphene, or androgens (typically testosterone) or aromatase inhibitors such as Letrozole are medical treatment options, although they are not universally approved for the treatment of gynecomastia. Endocrinological attention may help during the first 2–3 years. After that window, however, the breast tissue tends to remain and harden, leaving surgery (either liposuction, gland excision, skin sculpture, reduction mammoplasty, or a combination of these surgical techniques) as the only treatment option. Many American insurance companies deny coverage for surgery for gynecomastia treatment on the grounds that it is a cosmetic procedure. Radiation therapy is sometimes used to prevent gynecomastia in patients with prostate cancer prior to estrogen therapy. Compression garments can camouflage chest deformity and stabilize bouncing tissue bringing emotional relief to some. There are also many who choose to not treat the condition.

Prognosis

Gynecomastia is not physically harmful, but in some cases can be an indicator of other more serious underlying conditions. Growing glandular tissue, typically from some form of hormonal stimulation, is often tender or painful. Furthermore, it can frequently present social and psychological difficulties for the sufferer.^[12] Weight loss can alter the condition in cases where it is triggered by obesity, but losing weight will not reduce the glandular component and patients cannot target areas for weight loss. Massive weight loss can result in sagging tissues about the chest, chest ptosis. The size and geometry of the fibro-glandular tissue present is unique to each patient. This results in a range of physically apparent aesthetic deformities, for which, classification systems have been devised. ^[13]

A large glandular mass of male breast tissue (gynecomastia), length of 4.8" and width 2.5", was removed, in its entirety, through an extended 1.5" infraareolar incision. The gland appears as a whitish-grayish solid mass, as opposed to fatty tissue that is soft, yellowish, and lobulated. Liposuction alone is not an effective method for removing the solid glandular mass and will result in 10 to 35% recurrence of gynecomastia. In this particular patient after a radical excision of the gland the appearance of the chest was improved and the incision was practically unnoticeable.

See also

• Male bra
• Male lactation

References

External links

• What is gynecomastia? Children's Hospital Boston