Gynaecomastia

This refers to enlargement of the male breast (enlarged breast in men). It usually affects both breasts but may affect one breast. This occurs as a result of proliferation of glands of the breast. This is 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 bildout 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 25%. Though it does not always pose major health risk, Nevetheless, it is the single most important risk factor of breast cancer in men. Hence the need to seek medical advice about it.

Risk factors

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

Diagnosis for Gynaecomastia

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

Investigations that may be done include:

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

Principles of Management

Treatment of enlarged breast in men 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.

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