- Commonest condition affecting male breast
- Due to enlargement of both ductal and stromal tissue
- 'True' gynaecomastia = enlarged breast glandular tissue
- 'Pseudo' gynaecomastia = excess adipose 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
- 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
Classification (Simon's)
- Grade 1 - Minor breast enlargement without skin redundancy
- Grade 2a - Moderate breast enlargement without skin redundancy
- Grade 2b - Moderate breast enlargement with skin redundancy
- Grade 3 - Gross breast enlargement with breast ptosis
Management
- Reassurance that it is a benign and self-limiting condition
- Treatment of any underlying cause
Medical
- Limited number of studies of the effect of medical therapy
- Danazol may reduce breast size in 80% of patients
- Tamoxifen may reduce breast size and pain
- Tamoxifen is not licensed for the treatment of gynaecomastia in the
UK
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
Daniels I R, Layer G T. Gynaecomastia. Eur J Surg
2001; 167: 885-892.
Devalia H L. Layer G T. Current concepts in gynaecomastia.
Surgeon 2009; 7; 114-119.
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.
Wise G J, Roorda A K, Kalter R. Male breast disease.
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