Physiologic or idiopathic gynecomastia with no pathologic basis commonly develops in the newborn, during puberty, and in old age
Most patients are asymptomatic. If symptoms occur,they generally include breast tenderness or soreness or occasional troublesomenipples.
Breast: if gynecomastia exists, thickened breast tissue should be palpable under the nipple. If there is a small, hard,eccentrically located mass or if skin dimpling is found, suspect carcinoma. Testes: if testes appear small, consider a chromosome study. If asymmetric, evaluate for testicular tumor with ultrasound. Liver: assess for hepatomegaly or ascites. Thyroid: assess for hepatomegaly or ascites. Assess nutritional status.
Cirrhosis, malnutrition, hypogonadism, Klinefelter’s syndrome, neoplasms, renal disease, hyperthyroidism, or hypothyroidism.
Testicular tumors (i.e., Leydig cell and sertoli cell tumors, choriocarcinomas), adrenal tumors pituitary adenomas, and lung carcinomas.
Estrogens Cimetidine Marijauna Diazepam Spironolactone Digoxin Reserpine Theophylline
Pseudogynecoamstia is an increase in male breast size that results from fat deposition. There is no hyperplasia of breast tissue, and involvement is bilateral
No. Numerous clinical studies have failed to show an increased of breast cancer in men with gynecomastia. There is no evidence of an increased incidence in patients on long – term estrogen therapy or with drug –induced gynecomastia. No histologic evidence supports a relationship.
Testosterone can be effective in the treatment of gynecomastia secondary to testicular failure. Tamoxifen has been reduce gynecomastia in middle – aged men. Danazol acts as a gonadotropininhibitor, reducing both the pain and extent of gynecomastia.
Grade 1: small visible breast enlargement without skin redundancy Grade 2A: moderate breast enlargement without skin redundancy Grade 2B: moderate breast enlargement with skin redundancy Grade 3: marked breast enlargement and marked skin redundancy
Liposuction is most helpful as an adjunct to excision by smoothing the edges of the resection. The ideal candidate is the patient with fatty breasts responsive to fat aspirations. Although cannulas have been designed to break up fibrous septa, it is usually necessary to excise a small button of breast tissue.
Hematoma or seroma formation is very common secondary to extensive soft tissue dissection through a small incision with a substantial dead space. Good hemostasis and placement of a drain may be helpful. Evacuate any hematomas that may occur. Other less common complications include nipple slough and infection.