| Gynecomastia |
| Classification and external resources |
Male with severe gynecomastia and pseudogynecomastia |
| ICD-10 |
N62 |
| ICD-9 |
611.1 |
| MedlinePlus |
003165 |
Gynecomastia or Gynaecomastia, /ˌɡaɪnɨkɵˈmæstiə/, is the abnormal development of large mammary glands in males resulting in breast enlargement. The term comes from the Greek γυνή gyné (stem gynaik-) meaning "woman" and μαστός mastós meaning "breast." The condition can occur physiologically in neonates (due to female hormones from the mother), in adolescence, and in the elderly (Both in adolescence and elderly it is an abnormal condition associated with disease or metabolic disorders). In adolescent boys the condition is often a source of distress, but for the large majority of boys whose pubescent gynecomastia is not due to obesity, and when it's not severe it may shrink or disappear between the ages of 16-18. [1]
Photos of 22 year old from New York City with severe asymmetrical gynecomastia.A small incision was made only under the areola as opposed to around the entire nipple. For more angles, please click here
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Contents
- 1 Pathophysiology
- 2 Classification
- 3 Treatment and Male Breast Reduction Surgery
- 4 Prognosis
- 4.1 Health conditions related to gynecomastia
- 5 Gallery
- 6 See also
- 7 References
- 8 External links
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Pathophysiology
Gross Pathology:A large glandular mass of male breast tissue, surgically removed
Micrograph showing gynecomastoid hyperplasia, the changes seen in gynecomastia. H&E stain.
The causes of common gynecomastia remain uncertain, although it has generally been attributed to high levels of sex hormone-binding globulin (SHBG) resulting in low levels of free testosterone or the tissue responsiveness to them; a root cause is rarely determined for individual cases.Spironolactone (Aldactone), [2][3] Digoxin and Furosemide are reported to cause gynecomastia. [4] Breast prominence can result from hypertrophy of breast tissue, chest adipose tissue (fat) and skin, and is typically a combination. Breast prominence due solely to excessive adipose is often termed pseudogynecomastia[5] or sometimes lipomastia.[6]
Gynecomastia should be distinguished from muscle hypertrophy of the pectoralis muscles. When performing surgery the gland is sent to the lab to check for tumors in order to confirm the presence of gynecomastia and check for tumors. The tissue is examined under the microscope for review.
Classification
"Puffy nipples" is among the most common forms of gynecomastia.It is characterized by a glandular tissue accumulation concentrated under and typically confined to the areola, or can be slightly extended outside the areola forming a dome shaped appearance to the areola.
Pure glandular gynecomastia is common in bodybuilders and is thought to be a result of the use of anabolic steroids.[7] In this case it is known as anabolic-androgenic steroid (AAS) induced gynecomastia.[7] Due to excess testosterone levels from steroids, which is converted to estrogen, bodybuilders and other athletes are sometimes afflicted with gynecomastia in its purest form. Gynecomastia in lean men is usually only a breast tissue gland with little to no adipose tissue. Proper treatment of pure gynecomastia can be done only by excision of the breast tissue, which in the case of bodybuilders is by itself sufficient to achieve a flat nipple-areola complex. Liposuction is only rarely necessary.
Congenital or hereditary gynecomastia is typically evident by the ages of 12 to 18 in boys.[8] Thirty to sixty percent of young boys suffer from large male breasts.[8] As many as thirty percent may live with enlarged male breasts for the rest of their lives, but in other cases the gynecomastia will recede with age. However, severe forms of adolescent gynecomastia may require an intervention, including consultation with the patient, the parents, and child development professionals.
Unilateral / asymmetrical gynecomastia occurs when only one breast is larger due to gynecomastia, the other breast is typically normal in both size and shape. Bilateral asymmetry occurs when gynecomastia is present in both breasts, each to a different degree.
Older persons suffering from gynecomastia tend to have less skin elasticity and thus will have a greater abundance of excess skin related to gynecomastia.[9]
Related conditions
Enlarged Nipple are quite common and are often congenital (hereditary). Either the diameter of the nipple or the profile(length) or both are out of proportion and therefore are aesthetically unpleasant.In extreme cases there may be accompanied with discharge from the nipples. Enlarged nipples can be congenital and are often displayed later in life, but sometime can be seen in young people. When performed by an experienced board-certified plastic surgeon nipple reduction is the best solution
Pseudogynecomastia[5] typically presents with an enlarged diameter and or excessive areola projection. However, it is not composed of glandular tissue, but rather adipose tissue. It looks much like typical gynecomastia but requires different treatment. Exercise and diet may be effective in combating pseudogynecomastia. Only if this regimen is unsuccessful should surgery be considered. This is generally the only type of gynecomastia which can be improved with liposuction, but excision may be indicated in some cases.
Combined procedure Often, many patients seeking gynecomastia treatment, or male breast reduction surgery also end up pursuing liposuction of the waist, back and underarm. Many men seeking treatment for gynecomastia also have a build-up of fat around the abdomen which is referred to as an adipose belt. These patients will sometimes elect to undergo male breast reduction and liposuction of the waist and back at the same time.
Treatment and Male Breast Reduction Surgery
Surgical excision of the breast gland is paramount and results in a permanent,and consistently reliable outcome. According to plastic surgery literature, when excision is not performed the recurrence rate may be as high as 35%.This procedure has the best outcome when performed by a plastic surgeon who has a significant experience performing gynecomastia surgery.When done correctly recurrence is rare. Medication is hardly effective for mature gynecomastia,that is larger than 1 inch in diameter,or in existence for longer than six months.Liposuction does not remove the breast gland and instead is used to remove the surrounding adipose tissue.
Paying attention to endocrine levels may help during the first six months of gynecomastia development. However, after that time frame the breast tissue tends to remain and harden. This leaves surgery as the only treatment option. The included surgical procedures are: gland excision, or gland excision accompanied by liposuction. Skin sculpture is rarely necessary.
Some medications (for example: risperidone) are found to cause gynecomastia in some patients. Sometimes an alternative medication can be used to avoid gynecomastia side-effects. For example: instead of taking spironolactone, eplerenone can be taken.
Selective estrogen receptor modulator medications are treatment options, although they are not universally approved for gynecomastia treatment. Such treatments are: tamoxifen and clomifene, or androgens (typically testosterone) or aromatase inhibitors such as anastrozole.
Radiation therapy is sometimes used to prevent gynecomastia in patients with prostate cancer before estrogen therapy.
Compression garments can camouflage chest deformity and stabilize bouncing tissue; this brings emotional relief to some.
Many American insurance companies deny coverage for surgery for gynecomastia treatment or male breast reduction on the basis that it is a cosmetic procedure.
Prognosis
Gynecomastia is not physically harmful, but in some cases can be an indicator of other more serious underlying conditions, such as testicular cancer.[10][11][12] Growing glandular tissue, typically from some form of hormonal stimulation, is often tender or painful. Furthermore, it can frequently present social and psychological difficulties for the sufferer.[13] Weight loss can alter the condition in cases where it is triggered by obesity, but losing weight will not reduce the glandular component and patients cannot target areas for weight loss. Massive weight loss can result in sagging tissues about the chest, chest ptosis. The size and geometry of the fibro-glandular tissue present is unique to each patient. This results in a range of physically apparent aesthetic deformities, for which, classification systems have been devised. [14]
Health conditions related to gynecomastia
- Hypogonadism
- Any of the conditions that interfere with normal testosterone production, such as Klinefelter syndrome or pituitary insufficiency, can be associated with gynecomastia.
- Aging
- Hormone changes that occur with normal aging can cause gynecomastia, especially in men who are overweight.
- Tumors
- Some tumors, such as those involving the testes, adrenal glands or pituitary gland, can produce hormones that alter the male-female hormone balance.
- Hyperthyroidism
- In this condition, the thyroid gland produces too much of the hormone thyroxine.
- Kidney failure
- About half the people being treated with regular hemodialysis experience gynecomastia due to hormonal changes.
- Liver failure and cirrhosis
- Hormonal fluctuations related to liver problems as well as medications taken for cirrhosis are associated with gynecomastia.
- Malnutrition and starvation
- When the human body is deprived of adequate nutrition, testosterone levels drop, but estrogen levels remain constant, causing a hormonal imbalance. Gynecomastia can also occur once normal nutrition resumes.
Gallery
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Example in a body builder
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Example of gynecomastia in adolescent
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Example of pseudogynecomastia
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An example of asymmetric gynecomastia
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An example of the combined procedures gynecomastia surgery and liposuction of the waists (flanks)
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Patient before and after nipple reduction surgery
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55 year old male with moderate gynecomastia before and after male breast reduction surgery
See also
References
- Notes
- ^ Adolescent gynecomastia
- ^ Pitt, Bertram (1999-09-02). "The Effect of Spironolactone on Morbidity and Mortality in Patients with Severe Heart Failure". N Engl J Med. http://www.nejm.org/doi/full/10.1056/NEJM199909023411001#t=articleResults. Retrieved 2011-08-01.
- ^ Haynes, Bridgett; Mookadam, F (2009-08-01). "Male Gynecomastia". Mayo Clinic proceedings. Mayo Clinic (Mayo Clin Proc.) 84 (8): 672. doi:10.4065/84.8.672. PMC 2719518. PMID 19648382. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2719518.
- ^ Aiman, Umme; Haseeen, MA; Rahman, SZ (Dec 2009). "Gynecomastia: An ADR due to drug interaction". Indian J Pharmacol. 41 (6): 286–7. doi:10.4103/0253-7613.59929. PMC 2846505. PMID 20407562. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2846505.
- ^ a b Braunstein, Glenn D.; Braunstein, Glenn D. (Feb 18 1993). "Gynecomastia". New England Journal of Medicine 328 (7): 490–5. doi:10.1056/NEJM199302183280708. PMID 8421478.
- ^ Allee, Mark R (2006-11-15). "Gynecomastia". WebMD, Inc. (emedicine.com). http://www.emedicine.com/med/topic934.htm. Retrieved 2007-05-20.
- ^ a b Llewellyn, W (2009). William Llewellyn's Anabolics. pp. 43–44.
- ^ a b Bembo, SA; Carlson, HE (June 2004). "Gynecomastia: Its features, and when and how to treat it". Cleveland Clinic Journal of Medicine 71 (6): 511–517. doi:10.3949/ccjm.71.6.511. PMID 15242307.
- ^ Gerhardt, LC; Lenz, A; Spencer, ND; Münzer, T; Derler, S (Aug 2009). "Skin-textile friction and skin elasticity in young and aged persons". Skin Res Technol 15 (3): 288–98. doi:10.1111/j.1600-0846.2009.00363.x. PMID 19624425.
- ^ http://www.labtestsonline.org/understanding/conditions/testicular.html
- ^ http://emedicine.medscape.com/article/120858-overview
- ^ http://www.medhelp.org/posts/Urology/Gynecomastia-and-cancer-of-the-testies/show/912913
- ^ Wiesman IM, Lehman JA, Parker MG, Tantri MD, Wagner DS, Pedersen JC (August 2004). "Gynecomastia: an outcome analysis". Ann Plast Surg 53 (2): 97–101. PMID 15269574. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0148-7043&volume=53&issue=2&spage=97.
- ^ Simon BE, Hoffman S, Kahn S. Classification and surgical correction of gynecomastia. Plast Reconstr Surg 1973;51:48-52.
External links
- What is gynecomastia? Children's Hospital Boston
- Excessive alcohol consumption can lead to male breasts Fitho- Health & Fitness Resource
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Disorders of breast (N60–N64, 610–611)
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| Mastitis |
Puerperal mastitis (Breast engorgement) · Nonpuerperal mastitis (Subareolar abscess/Zuska's disease, Granulomatous mastitis)
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| Other |
Benign mammary dysplasia (Duct ectasia of breast · Chronic cystic mastitis) · Galactorrhea · Mastodynia · nipple (Nipple discharge, Inverted nipple, Fissure of the nipple) · Galactocele · Ptosis · Breast cyst · Breast lump · Fat necrosis of breast · Gynecomastia · Hypertrophy of breast
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