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• 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

Management

• Reassurance that it is a benign and self-limiting condition
• Treatment of any underlying cause

Surgery

• Cosmetic results of surgery can be disappointing
• Surgery can be considered if gynaecomastia is painful or cosmetically embarrassing
• Small areas of gynaecomastia can be excised through periareolar incision
• More extensive areas require either:
  • Liposuction
  • Breast reduction via circumareolar incision

Bibliography

Bembo S A,  Carlson H E.  Gynecomastia:  its features and when and how to treat it.  Cleve Clin J Med 2004;  71:  511-517

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.

Fruhstorfer B H,  Malata C M.  A systematic approach to the surgical treatment of gynaecomastia.  Br J Plast Surg 2003;  56:  237-246.

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.

Wise G J,  Roorda A K,  Kalter R.  Male breast disease.  J Am Coll Surg 2005;  200:  255-269.

Last updated: 05 January 2008

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