Gynecomastia is the abnormal development of breast tissue in men resulting in breast enlargement. The condition can occur physiologically (with no pathologic basis) in newborn males (due to circulating hormones from the mother), during adolescence, and in the elderly. Gynecomastia occurs in about 60% of adolescent boys to some extent and is often a source of distress. The peak age of onset is 14 years of age, and commonly lasts one to two years. For the large majority of boys whose pubescent gynecomastia is not due to obesity, the breast development decreases or in some cases completely disappears within a couple of years.
What causes gynecomastia?
The exact cause(s) of common (non-pathologic) gynecomastia remain unknown for certain. However, male breast enlargement has generally been attributed to some type of imbalance of sex hormones or the tissue responsiveness to them. A specific cause is rarely determined in individual cases. Gynecomastia may also result from increased or unopposed estrogen action on breast tissue. Approximately 4 to 10% cases of gynecomastia are thought to be due to drugs. Prescription medications known to cause gynecomastia include digoxin, furosemide, H-2 blocker antacids and several other anti-hypertensive drugs. Illicit drugs can also cause male breast enlargement; marijuana is the most common. There are several serious pathologic medical conditions that can cause gynecomastia by creating an excess of hormones. These include: liver cirrhosis, malnutrition, hypogonadism, hyper or hypo thyroidism, and hormone-producing tumors. There is no relationship between gynecomastia and male breast cancer. However, every male with breast enlargement should be evaluated by a physician to assess for this rare possibility.
What lab tests should be done?
Prepubertal males: Estradiol, LH, FSH, HCG.
Pubertal males: Estradiol, LH, FSH, HCG and testosterone.
Adult males: Estradiol, LH, FSH, HCG, testosterone, thyroid functions (TSH, T3 and T4), & liver/kidney functions.
What radiographs may be helpful?
1) CT scan of the adrenal glands if estradiol levels are abnormally elevated.
2) Ultrasound of the testes is HCG is abnormally elevated.
3) Chest x-ray in select adult males.
Who is a candidate for male breast reduction surgery?
1) Adolescent males with breast enlargement that persists for 12-18 months duration.
2) Symptomatic patients (pain, tenderness).
3) Disease of long duration that results in fibrosis of the breast tissues.
4) Patients at risk for carcinoma (i.e. Klinefelter’s syndrome).
Surgical options for male breast reduction:
1) Suction-assisted lipectomy: Liposuction alone works very well to reduce breast volume in gynecomastia patients whose breast tissue is mostly composed of fat.
2) Open mastectomy: For patients with significant fibrous breast parenchyma, open excision of the dense enlarged breast tissue is often required.
3) Breast lift with concurrent open mastectomy: Some patients (in particular older adults) will have great amounts of excess breast tissue. In these cases, both the fibrous breast tissue and the associated sagging breast skin will need to be reduced.