Service : Gynecomastia
Gynecomastia Gynecomastia
Gynecomastia is excessive development of the male breasts.

In what age groups does gynecomastia occur?

Physiologic or idiopathic gynecomastia with no pathologic basis commonly develops in the newborn, during puberty, and in old age.


Are patients with gynecomastia symptomatic?

Most patients are asymptomatic. If symptoms occur,they generally include breast tenderness or soreness or occasional troublesomenipples.


What physical findings should be sought?

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.


What are the most common causes of pathologic gynecomastia?

Cirrhosis, malnutrition, hypogonadism, Klinefelter’s syndrome, neoplasms, renal disease, hyperthyroidism, or hypothyroidism.


What tumors may lead to gynecomastia?

Testicular tumors (i.e., Leydig cell and sertoli cell tumors, choriocarcinomas), adrenal tumors pituitary adenomas, and lung carcinomas.


What drugs may cause gynecomastia?

Estrogens              Cimetidine     Marijauna         Diazepam

Spironolactone    Digoxin           Reserpine          Theophylline


Does gynecomastia ever resolve?

  • During puberty, gynecomastia often regresses spontaneously within 2 years.

  • In drug – related gynecomastia, withdrawal of the medication leads to regression.

  • If gynecomastia is of long duration, it is unlikely to regress spontaneously.


What is pseudogynecomastia?

Pseudogynecoamstia is an increase in male breast size that results from fat deposition. There is no hyperplasia of breast tissue, and involvement is bilateral. 


Is there any relationship between gynecomstia and breast cancer in adult males?

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.


What is the role of medical therapy?

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.


What are the indication for surgery in patients with gynecomastia?

  • Adolescent males with enlargement persisting for 18 – 24 months

  • Symptomatic patients.

  • Gynecomastia of long duration leading to fibrosis.

  • Patients at risk for carcinoma (e.g., patients with Klinefelter’s syndrome)


Describe the surgical classification 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


Discuss surgical techniques for gynecoamstia.

  • Mild-to-moderate gynecomastia. Excision of breast tissue either a semicircular incision along the inferior aspect of the areolaor a transverse incision in the apex of the axilla.

  • Moderate-to-large gynecomastia. With more severe cases, skin resection and nipple transposition techniques become necessary. After resecting skin, the nipple – areola is rotated superiorly and medially based on a single dermal pedicle.

  • Massive gynecomastia. In the most severe cases, en bloc resection of excessive skin and breast tissue and free nipple grafting can be performed. The final scar is placed within the inframammary crease using a cresenteric transverse incision. The nipple areolagraft is then placed on the dermis overlying the fifth rib.


What is the role of liposuction in the treatment of  Gynecomastia?

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.

What is most common complication after surgery?

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.


What techniques may prevent unwanted results?

  • Be sure to leave an adequate layer of subcutaneous fat over the pectoralis fascia to prevent a concave breast.

  • Perform liposuction to produce a smooth contour peripherally.

  • Leave a 1 – cm thick of adipose or glandular tissue beneath the areola to avoid nipple in version.



  • Scarless surgery

  • Smooth contour peripherally


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