Enlargement of the male breast is known medically as gynaecomastia. It usually affects both breasts but may affect one breast. It occurs as a result of proliferation of glands of the breast due to imbalance in the action of the hormones oestrogen and testosterone. It should not be confused with pseudogynaecomastia or lipomastia which occurs due to fat deposition without proliferation of breast glands. Occurence occurs in three peaks. First is in infancy in 60-90%. Second is in puberty in 4-69%, this is referred to as physiologic gynaecomastia. Third is at midlife in about 24-65%.Though it does not always pose major health risk, it is the single most important risk factor of breast cancer in men. Hence the need to seek medical advice about it.

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Risk factors

  • Family history of gynaecomastia
  • Obesity
  • Drugs: including but not limited to finasteride, spironolactone, cimetidine, metronidazole, anabolic steroids.
  • Alcohol
  • Genetic/congenital disorders e.g. Klinefelter Syndrome, congenital anorchia, androgen insensitivity syndrome
  • Testicular disease
  • Recreational drugs: amphetamine, marijuana, heroin
  • Hypogonadism
  • Hypoandrogenism
  • Hyperthyroidism
  • Chronic liver disease
  • Chronic kidney disease

Diagnosis

Diagnosis is based on history of breast swelling/pain and eliciting of risk factors, physical examination and investigations as indicated by findings from history and physical examination.

Investigations that may be done include:

  • Testosterone, oestradiol, luteinizing hormone assay
  • Testicular ultrasound scan
  • Breast ultrasound scan
  • Mammography
  • Karyotyping
  • TSH(Thyroid-stimulating hormone) and free thyroxine levels
  • Kidney function test
  • Liver function test

Principles of management

  • Treatment is not indicated for pubertal gynaecomastia as resolution is spontaneous usually within three years. However, they may benefit from counseling and reassurance.
  • Treatment of underlying disease, if identified, will often lead to resolution of symptoms.
  • In cases due to drug use ,the implicated drug should be discontinued or substituted if its indication is still present.
  • In patients whose predisposing factor can not be identified, drug therapy or surgery may be considered.
  • Drug therapy or surgery may also be considered in patients whose gynaecomastia persist even after treatment of underlying cause.
  • Commonly used drugs include tamoxifen, clomiphene and danazol.
  • Surgical options include reduction mammoplasty, donut mastopexy and subcutaneous mastectomy.

About Dr Habeeb Ali Tunde

Dr. Habeeb Ali Tunde provides the most effective treatments to patients by integrating both conventional and alternative medicine that address all aspects of pain and wellness.

Read more

Follow Dr Habeeb Tunde Ali

Facebook – Dr. Habeeb Ali

Twitter – Dr. Habeeb Ali

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Website: Dr. Habeeb Tunde Ali

Mentioned on Tribune Online News – Dr. Habeeb Tunde Ali