Gynecomastia:

Gynecomastia is usually a benign growth or enlargement of the male breast area resulting from a proliferation of the glandular component located in the breast. Gynecomastia is defined clinically by the presence of a rubbery or firm mass extending concentrically from the nipples. Fat deposition without glandular proliferation is termed pseudo gynecomastia. Although gynecomastia is usually bilateral, gynecomastia can also be unilateral.

Gynecomastia is a swelling of the breast tissue in males. It's cause is an imbalance of the hormones estrogen and testosterone. Babies, boys going through puberty and older men often develop gynecomastia from normal changes in hormone levels. Less often, gynecomastia is caused by a health condition such as liver disease, low testosterone production or a thyroid problem. Certain medications and illicit drugs, (steroids), that raise estrogen levels also can cause gynecomastia.

Gynecomastia isn't a serious problem unless it's a sign of an underlying health condition, but it can be tough to cope with. Men and boys with gynecomastia sometimes have pain or tenderness in their breasts and may feel embarrassed or unhappy with their bodies. Breast cancer is found in less than 5% of most cases.

Causes of Gynecomastia:

24% Persistent pubertal gynecomastia

10%-26% Drugs (most common-Anabolic Steroids).

 25% No detectable abnormality

8% Cirrhosis or malnutrition

8% Primary Hypogonadism

3% Tumor related (Testicular)

2% Secondary Hypogonadism

2% Hyperthyroidism

1% Chronic renal insufficiency

Dealing with Gynecomastia:

Choices of treatment for gynecomastia depend on several factors. The first is the cause of the disorder. If the gynecomastia is drug-induced, discontinuance of the agent may be all that is needed.

If it is pubertal, watchful waiting is in order, since in most patients the condition will resolve spontaneously.

Gynecomastia due to hyperthyroidism, acute hepatic disorders, or a recent onset of hypogonadism may remit in response to therapy for the underlying disorder.

The second consideration is whether the gynecomastia is an incidental finding, detected only by the physician, or is brought to the attention of the physician by the patient himself. Mild asymptomatic gynecomastia detected only through physical examination requires no therapy other than treatment of the underlying cause. 

A third factor to consider is the length of time the gynecomastia has been present. A number of histologic studies have shown that gynecomastia present for less than six months usually demonstrates an active, or florid, histologic picture, characterized by marked ductal epithelial hyperplasia, proliferation of the periductal mesenchymal tissue, and periductal edema.

In general, the indications for treatment include: marked pain and tenderness, severe embarrassment or emotional disturbance. The most uniformly effective therapy at any stage is surgical removal of the glandular tissue through a periareolar incision. In patients with a large amount of adipose tissue in the subglandular area, suction-assisted lipectomy may be performed at the time of surgery to improve the cosmetic results.

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