Gynecomastia is the benign enlargement of breast tissue in males caused by an imbalance of hormones like estrogen and testosterone. It can occur in adolescent boys due to hormonal changes or in older men due to certain medications, medical conditions, or tumors. Diagnosis involves physical exam, blood tests to check hormone levels, and imaging tests like mammograms or ultrasounds. Treatment options include medication to balance hormones, liposuction to remove fat tissue, or surgical removal of breast glandular tissue. Post-surgical care focuses on wound healing, pain management, and preventing complications like infections.

1. TOPIC :- GYNECOMASTIA
SUBJECT:-MEDICAL SURGICAL
NURSING-1
MADE BY :- SAMUEL PAUL

2. INTRODUCTION
OF
GYNECOMASTIA
 Gynecomastia is derived in Greek word Gnecco-
women or female , Masto –breast. Gynecomastia is
the common in the male adolescent boys can be
affected because secreted by the testes .this type
gynecomastia is virtually always benign and resolves
spontaneously in 1 to 2 years .Gynecomastia can also
occur in older men usually present as a firm ,tender
mass underneath the areola in these patient.
Gynecomastia may be diffuse and related to the use
of certain medications antibotic .it may also be
associated with certain condition including feminizing
testicular tumor infection in the testes.in
gynecomastia shape like female breast because
glandular breast tissue development testosterone less
to begin estrogen hormone production is high .

3. DEFINITION OF GYNECOMASTIA
ACCORDING TO B.VENKITESAN IS DEFINED AS
"GYNECOMASTIA IS THE BENIGN ENLARGEMENT
OF BREAST TISSUE IN MALE CAUSED BY AN
IMBALANCE OF THE HORMONES OESTROGEN
AND TESTOSTERONE".
01
ACCORDING TO BRUNNER AND SUDDARTH IS
DEFINED AS "FIRM OVERDEVELOPED BREAST
TISSUE TYPICALLY SEEN IN ADOLESCENT BOYS".
02

4. ANATOMY AND PHYSIOLOGY OF
GYNECOMASTIA
Normal anatomy and individual features of the breast
and regional lymph nodes in men are to be considered at
examination .Each breast located on the anterior surface
of the chest on the pectoral major muscles ,between
parasternal and anterior axillary lines with nipple on
middle clavicular line . Its corresponds to second to sixth
ribs .anatomy of the male breast down the lymph nodes
,nipple, aerola are shown on the outside of the breast.the
lymph nodes fatty tissues ducts and others part of the
inside of the breast are also shown .

5. ETIOLOGY OF GYNECOMASTIA
 HORMONAL CHANGES :- The hormones testosterone
and estrogen control sex characteristic in both men
and women testosterone controls male traits such as
mass muscle body hair
 ANTI ANDEROGENS :- It is used to treat an enlarged
prostate cancer and others condition e.g. Proscar,
Propecia.
 ANABIC STERIODS AND ANDROGENS :-
To treat hormone deficiencies ,delayed puberty or
muscle loss from another disease.
 AIDS medication :-the estrogen like properties of some
HIV medications can cause gynecomastia especially
efavirenz (sustiva )
 HEART MEDICATIONS :-Such as digoxin Lanoxin and
calcium channel blockers )
 AGING :- Hormones changes that
occurs with aging can cause gynecomastia.
 Hypogonadism:- conditions that lower testosterone
production such as Klinefelter syndrome or pituitary in
sufficiency .
 TUMOUR :-Some tumor such
as those involving testes adrenal gland or
pituitary gland .imbalanced of hormone.
 KIDNEY FAILURE :- About half
the people being treated with
dialysis experience gynecomastia due to hormonal
changes .
 LIVER FAILURE OR LIVER CIRRHOSIS :-Changes
in hormone level related to liver problems and
cirrhosis ,medications are associated with gynecomastia
 MALNUTRITION AND STARVATION :- When your
body is deprived of adequate nutrition testosterone leve
ls drop while the same causing a hormonal
imbalance .gynecomastia can also
happen when normal nutrition resumes .

6. PATHOPHYSIOLOGY
OF GYNECOMASTIA
DUE TO ETIOLOGICAL FACTOR
RESULTS FROM IMBALANCE BETWEEN THE ACTION OF
OESTROGEN AND ANDROGENS OF THE BREAST .
IT LEADS TO EXCESS SECREATION BY THE TESTICLES OR
ADRENAL GLANDS
ENLARGEMENT DEVLOPMENT OF BREAST TISSUE
OCCURS GYNECOMASTIA

7. CLINICAL
MANIFESTRATION OF
GYNECOMASTIA
 Swollen Breast tissue
 Breast tenderness
 Acute pain in chest
 Nipple discharge
 Skin reddish in color
 Inflammation in breast tissue
 Low immunity power and weakness
 Breast abscess

8. DIAGNOSTIC EVALUATION OF
GYNECOMASTIA
 History collection :- A historical data
collection specifies the attribute group to collect
data from, where to store the historical data, and
other information such as the collection frequency
and distribution.
 Physical examination :- Physical examination is the
process of evaluating objective anatomic findings
through the use of observation, palpation,
percussion, and auscultation.
 Testicular ultra sound :- testicular ultrasound is an
imaging procedure to examine the testicles and
other scrotal structures.
 Blood test :- blood levels of testosterone and estrogen
may provide clues regarding hormones misbalance that
may have caused gynecomastia .normal range of blood
:-
 Estrogen level-10 - 82 (pg./ml)
 Test Rogen level – 10 –35 (ng/l)
 Liver function test –7 –56 units/liter
 CBC (count blood cell) –4.3 - 5.9 million /mm3
 WBC{white blood cell )- 4,500- 11000/mm3
 Platelets – 150,000-400,000/mm3
 Hemoglobin – 13.5 - 17.5 (g /dl )
 Mammograms :- Gynecomastia is characterized by
hyperplasia the stromal ductal elements in the breast
clinically the breast is enlarged ,soft and tender and a mass
may be palpate in gynecomastia can be nodular .
 Computer tomography CT scan:- prominent areola with
dense subareolar ductal tissue are seen this can be a
common incident findings on computer tomography .
 Magnetic resonance imaging MRI :- MRI appearance of a
nodular bilateral asymmetric gynecomastia the pathologic
features of the nodular pattern nodular pattern of
gynecomastia include dilated fluid .filled mammary ducts
normal or hyper plastic ductal epithelium and intestinal
edema .
 Ultrasonography USG:- Sonographic , early, focal
gynecomastia appears as a triangular, hypoechoic mass in
the retro areolar area. As gynecomastia become diffuse, it
results in a hyperechoic increase in the glandular
parenchyma.

9. SURGICAL
MANGEMENT OF
GYNECOMASTIA
 OPEN SUBCUTANEOUS MASTECTOMY :-Subcutaneous
mastectomy involves removal of most of the breast tissue
with preservation of the nipple-areola complex.
Subcutaneous mastectomy can be performed as an open
procedure through an incision in the inframammary crease or
via a minimally invasive or endoscopic approach. Used to
remove all breast tissue if you have breast cancer or are
at very high risk of developing it.
 ENDOSCOPIC :- Endoscopic excision of gynecomastia
through a single lateral chest wall incision is a minimally
invasive effective and safe technique for the
management of gynecomastia, with excellent aesthetic
results .
 LIPOSUCTION ASSISTED MASTECTOMY :- Liposuction-
assisted mastectomy is the most popular method used for
pseudogynecomastia. The liposuction cannulas are inserted
through a 3-mm areolar incision or an incision in the anterior
axilla along the pectoralis major tendon. The surgeon the
removes fatty and minimal glandular tissues.

10. MEDICAL MANGEMENT OF
GYNECOMASTIA
 Testosterone-Mechanism of action
:- testosterone is an endogens steroid that helps is
development and Maintenace of male sex organs and
Maintenace of second sex character increased red blood
cell production –
 dose :- injection –testosterone cypionate 50 –400 mg
deep I.M .ethanoate 50 –400 mg I.M for 2-4 weeks
 Tamoxifen- Mechanism of action – tamoxifen is selective
estrogen receptor modulator indicate for reduction of the
breast cancer –
 dose –20 mg for 5 years .20 mg OD for up to 12 months.
 Testo lactone - Mechanism of action - it
is synthetic aromatase inhibit indicate as adjunctive in
palliative treatment advanced or disseminated breast
cancer .-
 dose –250 mg QID continue therapy for a minimum of
3 month.
 Clomiphene –Mechanism of action –clomiphene may
complete with estrogen receptor bindings sites and delay
replenishment of intracellular estrogen receptor –
 dose- 50 mg OD for 5 days subsequent doses may be
increased to 100 mg OD for 5 days.
 Danazol –Mechanism of action - it is synthetic
steroid analog with strong antigonadotrophic activity inhibits
L.H,FSH.-
 dose-weak androgenic action doses 200 mg B.D for 3 months
.
 Ethinyl estradiol –Mechanism of action- estrogen act binding
to nuclear estrogen receptor to specific DNA
sequence hormones response elements .-
 dose- HRT initially 0.05 mg 1-3 times
daily along with progesterone from 16-25 day male
hyper sexuality 0.05 mg daily .

11. NON-
PHARMACOLOGICAL
MANAGEMENT
 Warm water bag :- we are using warm water bag for
patient reduce their acute pain in the chest and
back pain .
 Fruits :- to reduce their
weakness citrus fruits apple ,organs, dark berries
 Personal hygiene :- to maintain personal
hygiene To the patient e.g. -sponge bath ,oral
hygiene ,catheterization etc. .
 Exercise :- to give exercise to the patient may
movement that makes muscles work and required
body to burn calories .

12. NUTRITIONAL
MANAGEMENT
 EATING HEALTHY FOOD :- salmon and tuna are rich in anti-
inflammatory properties. Furthermore, leafy greens, sweet
potatoes, berries, citrus fruits and beans are rich in
antioxidants. When you include both these foods in your
daily diet, you can get relief from the swelling and tenderness
caused due to gynecomastia
 WELL BALANCED DIET :-eggs, oysters, asparagus, figs,
almonds, nuts, brown rice, salmon, and avocados
 VEGETABLES AND PROTEIN :- Vitamin D helps to synthesize
steroid hormones, support bone health and Boost up
immunity Mushrooms Caviar Cereals
Trout.

13. NURSING MANGEMENT
 ASSEMENT OF THE PATIENT
 Take vital sign
 NURSING DIAGNOSIS
 Fatigue related to low amount of nutrition intake as evidence by subjective data .
 Disturb sleep pattern related to patient condition as evidence by objective data .
 Acute pain related to enlargement of chest or breast as evidence by facial
expression of patient .
 Impaired physical mobility related to lymph,nerve ,muscle as evidence by patient
condition
 Risk for infection related to low immunity as evidence by patient condition .
 Grieving related to loss of breast as evidence by observation .

14. HEALTH EDUCATION
 Well-balanced diet
 Exercise regularly
 Follow up
 Avoid smoking and alcohol
 Avoid junk foods
 Intake fresh juice

15. COMPLICATIONS
 Blood clots.
 Breast asymmetry.
 Breast contour
 shape irregularities.
 Changes in nipple or breast sensation may be temporary or Permenent
 Damage to deeper structures – such as nerves, blood vessels, muscles and lungs
– can occur and may be temporary or permanent
 Deep vein thrombosis, cardiac and pulmonary complications
 Fatty tissue found in the breast might die (fat necrosis)
 Fluid accumulation (seroma)
 Infection
 Persistent pain
 Poor wound healing
 Possibility of revision surgery
 Reactions to tape, suture materials, glues, topical preparations or injected agents
 Unfavorable scarring

16. SUMMARY OF GYNECOMASTIA
 Gynecomastia is a condition in which the glandular tissue in the breasts becomes enlarged in boys or
men, sometimes causing discomfort or nipple tenderness. It is usually the result of a hormonal
imbalance and typically occurs during infancy, adolescence, or mid to late life.
 the abnormal non-cancerous enlargement of one or both breasts in males due to the growth of
breast tissue as a result of a hormone imbalance between estrogen and androgen
 an increase in the amount of breast gland tissue in boys or men
 How to prevent from gynecomastia ?
 Dieting and exercising. Maintaining a proper diet and exercise can help balance hormones and burn fat
tissue.
 Stopping the use of drugs or steroids. Steroids and certain drugs can increase the risk of male breast
enlargement.
 Reducing alcohol intake. ...
 Hormone treatments. ...
 Losing weight.

17. ASSIGNMENT  Define the Gynecomastia ? Explain the etiology
of gynecomastia ?
 Describe the pathophysiology of Gynecomastia
? Explain the nursing management of
Gynecomastia ?
 Explain the clinical manifestation of
Gynecomastia ?
 Enlist the health Education of Gynecomastia ?
 Explain the surgical management of the
Gynecomastia ?

18. THANKYOU