Gynecomastia is the development of breast tissue in males. It commonly occurs during puberty in over half of boys and resolves on its own. It can also occur in older men. The breast tissue may appear as a lump and can affect one or both breasts. Causes include drugs, medical conditions, or idiopathic factors. Evaluation involves history, exam, and potential lab tests or imaging. Treatment depends on the underlying cause but may include watchful waiting, medications, liposuction, or surgical excision. Surgical procedures carry risks of numbness, blood supply issues, irregular contours, or infections.

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3.  Gynecomastia is the development of abnormally large
mammary glands in males resulting in breast enlargement.
 Gynaecomastia can happen in males of any age or weight.
 Gynaecomastia is very common in boys going through
puberty, happening in more than half of all normal
adolescent males, and usually goes away over time. In
older men, enlargement of the breast tissue happens in
about one-third of men.
 In about half of cases, enlargement is found in both
breasts; in the other cases it only affects one breast.
 Gynaecomastia can appear as a small lump that becomes
tender as the mass becomes larger.

4. Breast prominence due solely to excessive
adipose is often termed
pseudogynaecomastia or sometimes
lipomastia.
fat deposition without glandular
proliferation, on exam fingers will not meet
any resistance until they reach the nipple

5.  Gynecomastia has three peaks.
1. Infancy: 60-90% transient due to high maternal
estrogen. Normally regresses over 2-3 week
period.
2. Adolescence: 4-69% with wide variation due to
examiner observation. Onset 10-12y/o and
peaks 13-14y/o. Normally regresses w/in 18mo
and persistence uncommon after 17y/o.
3. Older men: 24-65% with highest prevalence in
the 50-80y/o.

6.  Drugs: 10-25%
(e.g: Digoxin, Furosemide, anabolic steroids,
marijuana, opioids and excessive alcohol intake)
 Idiopathic : 25%
 Persistent pubertal gynecomastia: 25%
 Cirrhosis or malnutrition: 8%
 Primary hypogonadism: 8%
 Testicular tumors: 3%
 Secondary Hypogonadism: 2%
 Hyperthyroidism: 1.5%
 Chronic renal insufficiency: 1%

7.  The basic mechanisms of gynecomastia include :
1.decrease in androgen production
2.an increase in estrogen production
3.increased availability of estrogen precursors for
peripheral conversion to estrogen.
 Androgen receptor blockade and increased binding
of androgen to sex-hormone binding globulin
(SHBG).
 Estrogen-like or antiandrogen effects of Drugs

8.  Family history
 Clinical examination
 Laboratory tests
 Imaging


9. ◦ Onset
◦ Bilateral/unilateral
◦ Pain
◦ Change in size
◦ Nipple discharge
◦ Drugs/medications
◦ PMH
◦ Family history

10. ◦ Look for signs and sx of liver and kidney disease
◦ Evaluate for hyperthyroidism, eg. Weight loss,
tachycardia, goiter, tremor, or exophthalmos.
◦ Seek for signs and sx that may suggest
hypogonadism, eg. Impotence, decreased libido,
strenght, and change in testicular size.
◦ Check for abdominal mass and testicular mass.
◦ Careful breast exam.

11. ◦ if gynecomastia of recent onset, persistent, or
painful/tender and has no clear physiologic etiology.
 BMP, LFT’s, TSH, LH, FSH, hCG, Prolactin, Estradiol, Testosterone,
Androstenedione
Imaging
◦ US and mammogram for any eccentric or discrete mass.

12.  Treat the underlying cause
 Watchful waiting
 Medical options:
 Androgens
 Anti-estrogens (as tamoxifen and
clomiphene)and aromatase inhibitors
 Aromatase inhibitors such as Letrozole

13.  Liposuction
 Gland excision
 Skin sculpture
 Reduction mammoplasty
 Or a combination of these surgical techniques

15. Permanent numbness, compromise of blood supply,
irregular contour, hematoma, seroma, wound
infection