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Gynaecomastia

Gynaecomastia

  • Commonest condition affecting male breast
  • Due to enlargement of both ductal and stromal tissue
  • It is benign and often reversible
  • Usually presents as unilateral non-tender breast enlargement

Aetiology

  • Most cases are idiopathic
  • Physiological causes are due to relative oestrogen excess
  • Physiological causes
    • Neonatal
    • Puberty
    • Senile
  • Pathological causes
    • Primary Testicular Failure
      • Anorchia
      • Klinefelter's Syndrome
      • Bilateral Cryptorchidism
      • Acquired Testicular Failure
      • Mumps
      • Irradiation
    • Secondary Testicular Failure
      • Generalised hypopituitarism
      • Isolated gonadotrophin deficiency
    • Endocrine Tumours
      • Testicular
      • Adrenal
      • Pituitary
    • Non-Endocrine Tumours
      • Bronchial carcinoma
      • Lymphoma
      • Hypernephroma
    • Hepatic Disease
      • Cirrhosis
      • Haemochromatosis
    • Drugs
      • Oestrogens and oestrogen agonists - digoxin, spironolactone
      • Hyperprolactinaemia - methyldopa, phenothiazines
      • Gonadotrophins
      • Testosterone target cell inhibitors - cimetidine, cyproterone Acetate

Prevalence of gynaecomastia with age

Management

  • Reassurance that it is a benign and self-limiting condition
  • Treatment of any underlying cause
  • If painful or embarrassing consider subcutaneous mastectomy
  • Performed through circumareolar incision

Bibliography

Colombo-Benkmann M,  Buse B,  Stern J,  Herfarth C.  Indications for and results of surgical therapy for male gynecomastia.  Am J Surg 1999;  178:  60-63.

Daniels I R,  Layer G T.  Gynaecomastia.  Eur J Surg 2001;  167:  885-892.

Gasperoni C,  Salgarello M,  Gasperoni P.  Technical refinements in the surgical treatment of gynaecomastia.  Ann Plast Surg 2000;  44:  455-458.

Glass A R.  Gynecomastia.  Endocrinol Metab Clin North Am 1994;  23:  825-837.

Williams T G  Dawson P M.  Gynaecomastia - presentation, aetiology and management.  Current Practice in Surgery 1992; 4: 105 - 109.

 

 
 

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