Gynecomastia or enlarged male breast.
Causes and surgical treatment.
Gynecomastia is an enlargement of the male breast where there is glandular overproduction.B Pseudo-gynecomastia is enlargement of the breast due to increase fat and not increasedB glandular proliferation. This usually occurs in males that are overweight.
The cause of enlarged breast tissue is an imbalance of hormones with an decrease testosterone -to- estrogen ratio.
Males will convertB hormones like testosterone to estrogen in the muscle, fat and skin.B In normal adult males the normal ratio of testosterone to estrogen is 300:1. 1B B A variety of factors can cause this ratio to go awry.
The prevalence of enlarged male breast tissue is about 40% based on autopsy data.
Male breast enlargement usually occurs at different times durning their life cycle.
The first time it occurs is in infancy due to the exposure to estrogens in utero.B Itb�s incidence is 60-90% and this condition regresses after the first 2-3 weeks when estrogen levels fall
The second peak occurs durning puberty with an incidence of about 40%.B This transient breast development occurs in boys aged 10-16.B This is due an an elevated conversion of estrogen durning the early adolescent period.B B With further development, this corrects itself.B By 3 years, 90% of the boys who experience beast enlargement will have spontaneous resolution.
The final peak occurs in older males particularly those aged 50-80 years-old.B The incidence is 24-65%.B This is usually due to weight gain in later life.B The fat cell is the major site where androgens are converted to estrogens.B Other factors include decreasing testosterone levels and the use of medications that can alter the testosterone:estrogen ratio.2
The following is a list of common causes of gynecomastia in males.
- Idiopathic (no detectable abnormality) 25-50%.
- Pubertal 25%.
- Medications 10-20%.
- Medical conditions and tumors 10-20%.B
The following medications have been associated with gynecomastia in males. 1,3,4
- Estrogens and estrogen agonist.
- Androgens and anabolic steroids.
Drugs used to treat T.B.
I have seen males that have used anabolic steroids for weight lifting that subsequently develop gynecomastia.
Patients that come in presenting to male gynecomastia need a through history and physical examination.B B Most will have male breast enlargement of unknown cause.
This condition causes embarrassment, and decrease self-esteem with most of the guys not wanting to take their shirts off or go topless while swimming.
The treatment for most of these patients is liposuction with or without breast tissue excision.B I find most men require liposuction and and some will also need to have the excess breast tissue removed.B I like to performB Vaser liposuction of the breast and then perform breast excision with an incision around the areola.B I find the fat is easier to remove when the Vaser is performed first.B Wong 5 in his study of treating male gynecomastia with standard versus ultrasound-assisted (Vaser) liposuction did a 13 year review.B He found using ultrasound was more effective than standard liposuction by having less subsequent revisions and conversions to open excision.
Most of my patients recover within 1 week after the procedure.B They will wear a compression vest and binder for 2-4 weeks for comfort.B Most also get liposuction of their abdomen and upper back for better contouring.
1. Allee MR, Baker MZ. Gynecomastia. e Medicine. August 12, 2008.
2. Cuhaci, N. et al. Gynecomastia: Clinical evaluation and management. Indian J Endocrinol Metab. 2014 Mar-Apr;18(2):150-158.
3. Braunstein, GD. Gynecomastia. J Engl J. Med. 1993;328(7):490-495.
4. Mahoney CP. Aldosecent gynecomastia differntial diagnosis and management. Pediatric Clin N. Am. 1990;37(6):1389-404.
5. Wong KY, Malata Cm. Conventional versus untrasound-assisted liposuction in gynecomastia surgery: A 13-year review. J Plast Reconstr Aesthet Surg. 2014 March 21 S 1748-6815(14)115-6.