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Gynecomastia

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Gynecomastia
Adult male with significant gynecomastia
Pronunciation
SpecialtyEndocrinology,plastic surgery
ComplicationsPsychological distress
Usual onsetAny age
DurationUsually up to 2 years, but can be lifelong
CausesIncreasedestrogen/androgenratio (physiologic, medications,chronic kidney disease,obesity,cirrhosis,malnutrition,certain cancers,anabolic steroids)
Diagnostic methodphysical exam, mammography (if indicated)
Differential diagnosisPseudogynecomastia,breast cancer
TreatmentLifestyle modifications,aromatase inhibitors,SERMs,or surgery

Gynecomastia(also spelledgynaecomastia)[a]is the abnormal non-cancerous enlargement of one or both breasts inmalesdue to the growth ofbreast tissueas a result of ahormone imbalancebetweenestrogensandandrogens.[4][5]Gynecomastia can cause significant psychological distress orunease.[6]

Gynecomastia can be normal in: newborn male babies, due to exposure to estrogen from the mother; adolescent boys going throughpuberty;older men, over age 50; andobesemen.[4]Most occurrences of gynecomastia do not require diagnostic tests.[4][5]Gynecomastia may be caused by abnormal hormone changes, any condition that leads to an increase in the ratio ofestrogens/androgenssuch asliver disease,kidney failure,thyroid diseaseand some non-breasttumors.Alcoholand some drugs can also cause breast enlargement.[4][7]Other causes may includeKlinefelter syndrome,metabolic dysfunction,or a natural decline intestosteroneproduction.[4][6][8]This may occur even if the levels of estrogens and androgens are both appropriate, but the ratio is altered.[7]

Gynecomastia is the most common benign disorder of the male breast tissue and affects 35% of men, being most prevalent between the ages of 50 and 69.[5][9]It is normal for up to 70% of adolescent boys to develop gynecomastia to some degree.[6]Of these, 75% resolve within two years of onset without treatment.[10]If the condition does not resolve within 2 years, or if it causes embarrassment, pain or tenderness, treatment is warranted.[11][12]Medical treatment of gynecomastia that has persisted beyond two years is often ineffective. Gynecomastia is different from "pseudogynecomastia",[5][6]which is commonly present in men withobesity.[13][14]

Medications such asaromatase inhibitorshave been found to be effective[15]and even in rare cases of gynecomastia from disorders such asaromatase excess syndromeorPeutz–Jeghers syndrome,[16]but surgical removal of the excess tissue can be needed to correct the condition.[17]In 2019, 24,123 male patients underwent the procedure in theUnited States,accounting for a 19% increase since 2000.[18]

Definition

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Gynecomastia is the abnormal non-cancerous enlargement of one or both breasts in men due to the growth ofbreast tissueas a result of ahormone imbalancebetweenestrogenandandrogen.[4][5]Gynecomastia is different from "pseudogynecomastia",[5][6]which is defined as an excess ofskinand/oradipose tissuein the malebreastswithout the growth of trueglandular breast tissue;[19][20][21]this is commonly associated withobesityand can be ruled out by physical exam.[13][14][21]

Signs and symptoms

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In gynecomastia there is always enlargement of one or both breasts, symmetrically or asymmetrically, in a man. A soft, compressible, and mobile mass ofbreast tissueis felt under thenippleandits surrounding skinin contrast to softerfattytissue which is not associated with a mass.[9][22]It may also be accompanied by breast tenderness or nipple sensitivity, which is commonly associated with gynecomastia observed in adolescents, typically early in development.[21]Gynecomastia that is painful, bothersome, rapidly-growing, associated with masses in other areas of the body, or persistent should be evaluated by a clinician for potential causes.[23]Dimpling of the skin, nipple discharge, and nipple retraction are not typical features of gynecomastia and may be associated with otherdisorders.[9]Milky dischargefrom the nipple is not a typical finding, but may be seen in a gynecomastic individual with aprolactin secreting tumor.[7]An increase in the diameter of theareolaand asymmetry of the chest are other possible signs of gynecomastia.[24]

Gynecomastia has psychosocial implications that may be particularly challenging for adolescents who are experiencing physical maturation and self-identity formation, which includes body image disturbances, negative attitudes towards eating, self-esteem problems, social withdrawal, anxiety, and shame.[25]Men with gynecomastia may appear anxious or stressed due to concerns about its appearance and the possibility of havingbreast cancer.[26][27]

Causes

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Gynecomastia is thought to be caused by an altered ratio of estrogens to androgens mediated by an increase in estrogen action, a decrease in androgen action, or a combination of these two factors.[7]Estrogen and androgens have opposing actions on breast tissue: estrogens stimulate proliferation while androgens inhibit proliferation.[7][26]The cause of gynecomastia is unknown in around 25% of cases.[22][27]Known causes can be physiologic (occurring normally) or non-physiologic due to underlying pathologies such as drug use, chronic disease, tumors, or malnutrition.

Physiologic

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Physiologic or normal gynecomastia can occur at three timepoints in life: shortly after birth in both female and male infants, during puberty in adolescent males, and in older adults over the age of 60.[28]

Newborns

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60-90% of male and female newborns may show breast development at birth or in the first weeks of life.[26][29]During pregnancy, theplacentaconverts the androgenic hormonesdehydroepiandrosterone(DHEA) andDHEA sulfateto the estrogenic hormonesestroneandestradiol,respectively; after these estrogens are produced by the placenta, they are transferred into thebaby'scirculation, thereby leading to temporary gynecomastia in the baby.[26][30]In some infants, neonatal milk (also known as "witch's milk") can leak from the nipples.[22]The temporary gynecomastia seen in newborn babies usually resolves after two or three weeks.[26]

Adolescents

[edit]
Gynecomastia of boys going throughpuberty

Hormonal imbalance (elevated ratio of estrogen to androgen) during early puberty, either due to decreased androgen production from the adrenals and/or increased conversion of androgens to estrogens, leads to transient gynecomastia in adolescent males. It can occur in up to 65% of adolescents as early as age 10 and peaks at ages 13 and 14.[31][32]It is self-limited in 75–90% of adolescents and usually resolves spontaneously within 1 to 3 years as pubertal progression increases testosterone levels and cause regression of breast tissue.[31][26]By age 17, only 10% of adolescent males have persistent gynecomastia.[31]

Older adults

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Declining testosterone levels and an increase in the level of subcutaneousfatty tissueseen as part of the normal aging process can lead to gynecomastia in older males. Increased fatty tissue, a major site of aromatase activity, leads to increased conversion of androgenic hormones such as testosterone to estrogens.[26]Additionally, levels ofsex hormone binding globulin(SHBG) increase with age and bind with less affinity to estrogen than androgens.[28]Put together, the elevated ratio of estrogen to androgen leads to gynecomastia, also known as senile gynecomastia in this group.[26]There is a 24–65% prevalence of senile gynecomastia in older males.[26]

Non-physiologic

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Drugs

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An exceptional case of extreme gynecomastia in a 63-year-old man, treated with thenonsteroidal antiandrogenflutamidefor prostate cancer. (a) With flutamide; (b) after discontinuation of flutamide.[33]More than 90% of cases of gynecomastia with nonsteroidal antiandrogens including flutamide are mild to moderate.[34][35]

About 10–25% of gynecomastia cases are estimated to result from the use of medications or exogenous chemicals.[17][27]Drugs can increase estrogen activity or increase the estrogen to androgen ratio through various mechanisms, such as binding to estrogen receptors, promoting estrogen synthesis, providing precursors that can be aromatized into estrogen, causing damage to the testes, inhibiting testosterone synthesis, inhibiting the action of androgens, or displacing estrogen from SHBG.[28]Drugs with good evidence for association with gynecomastia includecimetidine,ketoconazole,gonadotropin-releasing hormone analogues,human growth hormone,human chorionic gonadotropin,5α-reductase inhibitorssuch asfinasterideanddutasteride,certain estrogens used forprostate cancer,andantiandrogenssuch asbicalutamide,flutamide,andspironolactone.[7][17][36][37]

Drugs with fair evidence for association with gynecomastia includecalcium channel blockerssuch asverapamil,amlodipine,andnifedipine;risperidone,olanzapine,anabolic steroids,[17][38]alcohol,opioids,efavirenz,alkylating agents,andomeprazole.[17][39]Certain components of personal skin care products such aslavender[40]ortea tree oilhave been reported to cause prepubertal gynecomastia due to its estrogenic and anti-androgenic effects.[41][42]Certain dietary supplements such asdong quaiandTribulus terrestrishave also been associated with gynecomastia.[27]

Refeeding gynecomastia

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Malnutrition and significant loss of body fat suppress gonadotropin secretion, leading to hypogonadism. This is reversible when adequate nutrition resumes, where the return of gonadotropin secretion and gonadal function cause a transient imbalance of estrogen and androgen that mimics puberty, resulting in transient gynecomastia.[43]This phenomenon, also known as refeeding gynecomastia, was first observed when men returning home from prison camps during World War II developed gynecomastia after resuming a normal diet. Similar to pubertal gynecomastia, refeeding gynecomastia resolves on its own in 1–2 years.[43][7]

Chronic disease

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Many kidney failure patients experience a hormonal imbalance due to the suppression of testosterone production and testicular damage fromhigh levels of ureaalso known as uremia-associated hypogonadism.[27][44]Additionally, gynecomastia has been observed in 50% of patients with chronic kidney disease undergoing dialysis. Similar to the mechanism behind refeeding gynecomastia, dialysis allows patients with renal failure who were previously malnourished to expand their diets and regain weight. Dialysis-associated gynecomastia resolves spontaneously within 1–2 years.[7][26]

In individuals with liver failure or cirrhosis, the liver's ability to properly metabolize hormones such as estrogen may be impaired. Additionally, those with alcoholic liver disease are further put at risk for development of gynecomastia;ethanolmay directly disrupt the synthesis of testosterone and the presence ofphytoestrogensin alcoholic drinks may also contribute to a higher estrogen to testosterone ratio.[27]Conditions that can causemalabsorptionsuch ascystic fibrosisorulcerative colitismay also produce gynecomastia.[27]

A small proportion of male gynecomastia cases may be seen with rare inherited disorders such asspinal and bulbar muscular atrophyand the very rarearomatase excess syndrome.[45][46]

Hypogonadism

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Gynecomastia can be caused by absolute deficiency in androgen production due to primary or secondary hypogonadism. Primary hypogonadism results when there is damage to the testes (due to radiation, chemotherapy, infections, trauma, etc), leading to impaired androgen production.[7]It can also be caused by chromosomal abnormality seen in Klinefelter syndrome, which is associated with gynecomastia in about 80% of cases.[43][26]Secondary hypogonadism results when there is damage to the hypothalamus or pituitary (due to radiation, chemotherapy, infection, trauma, etc), and similarly lead to impaired androgen production. The net effect is reduced androgen production while serum estrogen levels (from peripheral aromatization of androgens) remain unaffected.[7][28]The lack of androgen-mediated inhibition of breast tissue proliferation combined with relative estrogen excess result in gynecomastia.[7]

Tumors

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Testicular tumors such asLeydig cell tumors,Sertoli cell tumors[47](such as inPeutz–Jeghers syndrome)[10]andhCG-secretingchoriocarcinoma[39]may result in rapid-onset gynecomastia by causing excess production of estrogen.[7]Other tumors such asadrenal tumors,pituitary gland tumors (such as aprolactinoma), orlung cancer,can produce hormones that alter the male–female hormone balance and cause gynecomastia.[22]

Individuals withprostate cancerwho are treated withandrogen deprivation therapymay experience gynecomastia.[48]

Pathophysiology

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Pathology: A large glandular mass of male breast tissue, surgically removed
Microscopic imageshowing gynecomastoid hyperplasia, the cellular changes seen in gynecomastiaH&E stain

The causes of common gynecomastia remain uncertain, but are thought to result from an imbalance between the actions of estrogen, which stimulates breast tissue growth, and androgens, which inhibit breast tissue growth.[8][17]Breast prominence can result fromenlargementof glandular breast tissue, chestadipose tissue(fat) and skin, and is typically a combination.[39]As in females, estrogen stimulates the growth of breast tissue in males.[7]In addition to directly stimulating breast tissue growth, estrogens indirectly decrease secretion of testosterone by suppressingluteinizing hormonesecretion, resulting in decreased testicular secretion of testosterone.[7]

Estrogen excess

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One of the main mechanisms for imbalance between estrogens and androgens is the overproduction of estrogens. A possible cause may be aneoplasmthat originates from estrogen-secreting cells.[49]Tumors that producehCGstimulate production of estradiol while reducing other testicular hormone production.[50]Obesityis another common cause of excess serum estrogens due to the presence ofaromatasein peripheral tissue, which is a protein that converts androgens into estrogens.[50]Peutz-Jeghers syndromeis a rare cause of testicular tumors that affect aromatase expression, which results in elevated serum estrogen levels.[51]Aromatase excess syndromeis a rare genetic disorder that leads to increased conversion of androgens to estrogens in the body.

Androgen deficiency

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Primaryhypogonadism(indicating an intrinsic problem with thetestesin males) leads to decreased testosterone synthesis and increasedconversion of testosterone to estradiolpotentially leading to a gynecomastic appearance.[26]Klinefelter syndromeis a notable example of a disorder that causes hypogonadism and gynecomastia, and has a higher risk of breast cancer in males (20–50 times higher than males without the disorder).[52]Secondary hypogonadism(indicating a problem with the brain) leads to decreased production and release ofluteinizing hormone(LH, a stimulatory signal for endogenous steroid hormone synthesis) which leads to decreased production of testosterone and estradiol in the testes.[26]

Increased levels of sex hormone-binding globulin

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Estrogens can increase blood levels of the proteinsex hormone-binding globulin(SHBG), which binds free testosterone (the active form) more strongly than estrogen, leading to decreased action of testosterone in male breast tissue.[7][50]Conditions such ashyperthyroidismandchronic liver diseaseaffect levels of SHBG, leading to symptomatic gynecomastia.[49]

Androgen resistance

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Dysfunction in the androgen receptor prevents the effects of testosterone from acting on its target tissues. Androgen insensitivity syndromes result from the different degrees of resistance to the effects of androgens, and can cause externalgenitaliathat may not be aligned with thegenotypeof the individual'ssex chromosomes.[53]Complete androgen insensitivity syndromeresults in the failure to develop external genitalia such as the penis and scrotum along with development of breasts in an individual with testes.Partial androgen insensitivity syndromemay result in a variety of presentations. Minimal androgen insensitivity syndrome may present as gynecomastia in adolescence and may additionally be associated withinfertility.[53]

Medications

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Medications are known to cause gynecomastia through several different mechanisms. These mechanisms include increasing estrogen levels, mimicking estrogen, decreasing levels of testosterone or other androgens, blocking androgen receptors, increasing prolactin levels, or through unidentified means.[26]Potential causative agents includeoral contraceptive pills,spironolactone,andanabolic steroids.[54]

High levels of prolactin in the blood(which may occur as a result of certain tumors or as a side effect of certain medications) has been associated with gynecomastia.[26]A high level of prolactin in the blood can inhibit the release ofgonadotropin-releasing hormoneand therefore cause secondary hypogonadism.[7][26]Receptors for prolactin and other hormones includinginsulin-like growth factor 1,insulin-like growth factor 2,luteinizing hormone,progesterone,andhuman chorionic gonadotropinhave been found in male breast tissue, but the impact of these various hormones on gynecomastia development is not well understood.[7]

Chronic disease

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Individuals who havecirrhosisor chronic liver disease may develop gynecomastia for several reasons. Those diagnosed with cirrhosis tend to have increased secretion of the androgenic hormoneandrostenedionefrom the adrenal glands, increased conversion of this hormone into various types of estrogen,[7]and increased levels of SHBG, which leads to decreased blood levels of free testosterone.[26]Around 10–40% of males withGraves' disease(a common form ofhyperthyroidism) experience gynecomastia.[26]Increased conversion of testosterone to estrogen by increased aromatase activity,[7]increased levels of SHBG and increased production of testosterone and estradiol by the testes due to elevated levels of LH cause the gynecomastia. Proper treatment of the hyperthyroidism can lead to the resolution of the gynecomastia.[26]

Estrogen excess Androgen deficiency Increased levels of sex hormone-binding globulin Androgen resistance Medications

Diagnosis

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To diagnose gynecomastia, a thorough history and physical examination are obtained by aphysician.Important aspects of the physical examination include evaluation of the male breast tissue with palpation to evaluate for breast cancer andpseudogynecomastia(male breast tissue enlargement solely due to excessfatty tissue), evaluation ofpenilesize and development, evaluation oftesticulardevelopment and an assessment for masses that raise suspicion fortesticular cancer,and proper development ofsecondary sex characteristicssuch as the amount and distribution ofpubicandunderarm hair.[7]Gynecomastia usually presents with bilateral involvement of the breast tissue but may occur unilaterally as well.[27]

Diagnosis of men with breast enlargement can be evaluated using analgorithm.A review of the medications or substances an individual takes may reveal the cause of gynecomastia.[27]Recommended laboratory investigations to find the underlying cause of gynecomastia include tests foraspartate transaminaseandalanine transaminaseto rule out liver disease, serumcreatinineto determine if kidney damage is present, andthyroid-stimulating hormonelevels to evaluate for hyperthyroidism. If these initial laboratory tests fail to uncover the cause of gynecomastia, then additional tests to evaluate for an underlying hormonal balance due tohypogonadismor a testicular tumor should be checked including total and free levels oftestosterone,luteinizing hormone,follicle stimulating hormone,estradiol,serum betahuman chorionic gonadotropin(β-hCG), andprolactin.[27]

High levels of prolactinare uncommon in people with gynecomastia.[27]If β-hCG levels are abnormally high, thenultrasoundof the testicles should be performed to check for signs of a hormone-secreting testicular tumor.[27]Markers of testicular, adrenal, or other tumors such as urinary17-ketosteroidor serumdehydroepiandrosteronemay also be checked if there is evidence of hormonal imbalance on physical examination. If this evaluation does not reveal the cause of gynecomastia, then it is considered to be idiopathic gynecomastia (of unclear cause).[27]

Differential diagnosis

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While there can be many potential causes of male patients that present with increased breast tissue, differential diagnoses are most concerning for gynecomastia, pseudogynecomastia, andbreast cancer(which is rare in men). Other potential causes of male breast enlargement such asmastitis,[27][55]lipoma,sebaceous cyst,dermoid cyst,hematoma,metastasis,ductal ectasia,fat necrosis,or ahamartomaare typically excluded before making the diagnosis.[27]

Imaging

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Mammographyis the method of choice for radiologic examination of male breast tissue in the diagnosis of gynecomastia when breast cancer is suspected on physical examination.[7][9]If a mass/lump is felt during a physical exam some features of the lump that would point to malignancy would be painless, non moveable (fixed), irregularly shaped, and skin changes. Mammography is rarely indicated for men since breast cancer is an unlikely diagnosis.[7]If mammography is performed and does not reveal findings suggestive of breast cancer, further imaging is not typically necessary.[9]If a tumor of theadrenal glandsor thetestesis thought to be responsible for the gynecomastia,ultrasoundexamination of these structures may be performed.[7]

Histology

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Gynecomastoid hyperplasia - Low magnification

Early histological features expected to be seen on examination of gynecomastic tissue attained byfine-needle aspirationbiopsy include the following: proliferation and lengthening of the ducts, an increase in connective tissue, an increase in inflammation, andswellingsurrounding the ducts, and an increase infibroblastsin the connective tissue.[26]Chronic gynecomastia may show different histological features such as increased connective tissuefibrosis,an increase in the number of ducts, less inflammation than in the acute stage of gynecomastia, increased subareolar fat, and hyalinization of the stroma.[24][26]When surgery is performed, the gland is routinely sent to the lab to confirm the presence of gynecomastia and to check for tumors under a microscope. The utility of pathologic examination of breast tissue removed from male adolescent gynecomastia patients has recently been questioned due to the rarity of breast cancer in this population.[56]

Classification

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The spectrum of gynecomastia severity has been categorized into agrading system:[57]

  • Grade I: Minor enlargement, no skin excess
  • Grade II: Moderate enlargement, no skin excess
  • Grade III: Moderate enlargement, skin excess
  • Grade IV: Marked enlargement, skin excess

Treatment

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If the gynecomastia doesn't resolve on its own in two years, then medical treatment is necessary. The options are medication or surgical intervention.[58]

Medication

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Gynecomastia can respond well to medical treatment although it is usually only effective when done within the first two years after the start of male breast enlargement.[7]Selective estrogen receptor modulators(SERMs) such astamoxifen,raloxifene,andclomifenemay be beneficial in the treatment of gynecomastia but are not approved by theFood and Drug Administrationfor use in gynecomastia.[7][17][59]Clomifene seems to be less effective than tamoxifen or raloxifene.[59]Tamoxifen may be used to treat gynecomastia in adults and of the medical treatments used,tamoxifenis the most effective.[60][61]Recent studies have shown that treatment with tamoxifen may represent a safe and effective mode of treatment in cases of cosmetically disturbing or painful gynecomastia.[17][62]Aromatase inhibitors(AIs) such asanastrozolehave been used off-label for cases of gynecomastia occurring during puberty but are less effective than SERMs.[16][59]

A few cases of gynecomastia caused by the rare disordersaromatase excess syndromeandPeutz–Jeghers syndromehave responded to treatment with AIs such as anastrozole.[16]Androgens/anabolic steroidsmay be effective for gynecomastia.[59]Testosteroneitself may not be suitable to treat gynecomastia as it can bearomatizedinto estradiol, but nonaromatizable androgens liketopicalandrostanolone(dihydrotestosterone) can be useful.[59]

Surgery

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Male with asymmetrical gynecomastia, before and after excision of the gland and liposuction of the waist

If chronic gynecomastia does not respond to medical treatment, surgical removal of glandular breast tissue is usually required.[17]The American Board of Cosmetic Surgery reports surgery is the "most effective known treatment for gynecomastia."[63]Surgical treatment should be considered if the gynecomastia persists for more than 12 months, causes distress (ie physical discomfort or psychological distress), and is in the fibrotic stage.[64]In adolescent males, it is recommended that surgery is postponed until puberty is completed (penile and testicular development should reachTanner scaleStage V).[64]

Surgical approaches to the treatment of gynecomastia includesubcutaneous mastectomy,liposuction-assisted mastectomy, laser-assisted liposuction, and laser-lipolysis without liposuction. Complications of mastectomy may includehematoma,surgical wound infection, breast asymmetry, changes in sensation in the breast, necrosis of the areola or nipple,seroma,noticeable or painful scars, and contour deformities.[57]In 2019, 24,123 male patients underwent surgical treatment for gynecomastia in the United States, accounting for a 19% increase since 2000. Thirty-five percent of those patients were between the ages of 20 and 29, and 60% were younger than age 29 at the time of the operation. At an average surgeon's fee of $4,123, gynecomastia surgery was also the 11th most costly male cosmetic surgery of 2019.[18]

Others

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Radiation therapyand tamoxifen have been shown to help prevent gynecomastia and breast pain from developing in prostate cancer patients who will be receiving androgen deprivation therapy. The efficacy of these treatments is limited once gynecomastia has occurred and are therefore most effective when used prophylactically.[65]

In the United States, many insurance companies deny coverage for surgery for gynecomastia treatment or male breast reduction on the basis that it is a cosmetic procedure.[66][67][68][69]

Prognosis

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Gynecomastia itself is a benign finding. It does not confer a poor prognosis, for some patients with underlying pathologies such astesticular cancerthe prognosis may be worse.[7]Theglandular tissuetypically grows under the influence of hormonal stimulation and is often tender or painful. Furthermore, gynecomastia frequently presents social and psychological difficulties such as low self-esteem, depression or shame.[56][57]

Epidemiology

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Gynecomastia is the most common benign disorder of the male breast tissue and affects 35 percent of men, being most prevalent between the ages of 50 and 69.[5][9]

New cases of gynecomastia are common in three age populations: newborns, adolescents, and men older than 50 years.[57]Newborn gynecomastia occurs in about 60–90 percent of male babies and most cases resolve on their own in about 2–3 weeks after delivery.[26][27]During adolescence, on average 33 percent of males are estimated to exhibit signs of gynecomastia.[7]Gynecomastia in older men is estimated to be present in 24–65 percent of men between the ages of 50 and 80. Estimates on asymptomatic gynecomastia is about up to 70% in men aged 50 to 69 years.[26][49]

Theprevalenceof gynecomastia in men may have increased in recent years, but the epidemiology of the disorder is not fully understood.[39]The use of anabolic steroids and exposure tochemicals that mimic estrogenin cosmetic products,organochlorine pesticides,and industrial chemicals have been suggested as possible factors driving this increase.[39][69]According to theAmerican Society of Plastic Surgeons,breast reduction surgeries to correct gynecomastia are fairly common but has been a recent decline. In 2020, there were over 18,000 procedures of this type performed in the United States which is down 11% compared to in 2019.

History

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The term gynaecomastia was coined byGalen.He also recognised glandular enlargement of the male breast; however, this wasn't a condition of gynaecomastia according to him.[70]A surgical procedure for treatment of gynaecomastia was described byAlbucasisin his second book ofKitab al-Tasrif.[71]

Society and culture

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Gynecomastia can result in psychological distress for those with the condition. Support groups exist to help improve the self-esteem of affected people.[69]

Moob,aportmanteauofmanandboob,is a popular term to refer to male breasts. Use ofanabolic steroidscan result in gynecomastia, and male breasts are sometimes referred to using the pejorativebitch titsinbodybuildingcommunities.[72]

InMurray v.Janssen Pharmaceuticals,Murray was a Risperidone user who was prescribed the medication at age nine and developed male breasts. A jury decided in Murray's favor in November 2015 and awarded him $1.75 million. The $1.75 million jury verdict represented damages for "disfigurementand mental anguish, "though it was later reduced to $680,000.[73]In the second portion of the bifurcated trial, the plaintiffs sought to prove that the companies knew and deliberately disregarded evidence that Risperidone could lead to gynecomastia in young males, and nonetheless promoted the medicationoff-labeland released the medication into the open market for prescription and use by patients without disclosing the side effects.[73]The jury found for the plaintiffs in the second portion of the trial and awarded $8 billion inpunitive damages.The amount was later reduced to $6.8 million by Judge Kenneth Powell Jr.[74]

In 2019, a 12-person Philadelphia jury awarded $8 billion in punitive damages to plaintiffs tied to the use ofrisperidone.Risperidone is anatypical antipsychoticthat was originally approved to treat psychosis, but its use in children, including those withautism,ADHD,andschizophreniadiagnoses, has grown over the last two decades.[75]

Etymology

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The term comes fromGreekγυνήgyné(stemgynaik-) 'female' andμαστόςmastós'breast'.[3]

See also

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References

[edit]
Explanatory notes
  1. ^The term comes from theGreekγυνήgyné(stemgynaik-) meaning "female" andμαστόςmastósmeaning "breast".[3]
Citations
  1. ^"Gynaecomastia | Definition of Gynaecomastia by Oxford Dictionary on Lexico.com".Lexico Dictionaries | English.OxfordDictionaries.com.Archived fromthe originalon 8 March 2021.Retrieved17 November2020.
  2. ^"Definition of Gynecomastia".www.merriam-webster.com.Retrieved17 November2020.
  3. ^abIuanow, Elaine; Kettler, Mark; Slanetz, Priscilla J. (March 2011). "Spectrum of Disease in the Male Breast".American Journal of Roentgenology.196(3): W247–W259.doi:10.2214/AJR.09.3994.PMID21343472.
  4. ^abcdef"Breast enlargement in males: MedlinePlus Medical Encyclopedia".medlineplus.gov.2018.Retrieved25 November2020.Updated by Brent Wisse (10 November 2018)
  5. ^abcdefgThiruchelvam, Paul; Walker, Jonathan Neil; Rose, Katy; Lewis, Jacqueline; Al-Mufti, Ragheed (22 September 2016). "Gynaecomastia".BMJ.354:i4833.doi:10.1136/bmj.i4833.PMID27659195.S2CID220098795.
  6. ^abcdeNiewoehner, CB; Schorer, AE (March 2008)."Gynaecomastia and breast cancer in men".British Medical Journal.336(7646): 709–713.doi:10.1136/bmj.39511.493391.BE.PMC2276281.PMID18369226.
  7. ^abcdefghijklmnopqrstuvwxyzaaNarula, Harmeet S.; Carlson, Harold E. (November 2014). "Gynaecomastia—pathophysiology, diagnosis and treatment".Nature Reviews Endocrinology.10(11): 684–698.doi:10.1038/nrendo.2014.139.PMID25112235.S2CID40159424.
  8. ^abJohnson RE, Murad MH (November 2009)."Gynecomastia: pathophysiology, evaluation, and management".Mayo Clinic Proceedings.84(11): 1010–1015.doi:10.4065/84.11.1010.PMC2770912.PMID19880691.
  9. ^abcdefChau, A; Jafarian, N; Rosa, M (February 2016)."Male Breast: Clinical and Imaging Evaluations of Benign and Malignant Entities with Histologic Correlation".The American Journal of Medicine(Review).129(8): 776–91.doi:10.1016/j.amjmed.2016.01.009.PMID26844632.
  10. ^abShulman, D. I.; Francis, G. L.; Palmert, M. R.; Eugster, E. A.; Lawson Wilkins Pediatric Endocrine Society Drug and Therapeutics, Committee. (1 April 2008). "Use of Aromatase Inhibitors in Children and Adolescents With Disorders of Growth and Adolescent Development".Pediatrics.121(4): e975–e983.doi:10.1542/peds.2007-2081.PMID18381525.S2CID39852740.
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