Gynecomastia

Abstract

: This review article provides an overview of gynecomastia based on the current available literature. Despite being the most common breast condition in men, there is a paucity of quality data and a lack of consensus on diagnosis, classification, workup, and treatment options. True gynecomastia must be distinguished from pseudogynecomastia. While the etiology is often multifactorial, gynecomastia is often related to an elevated estrogen to androgen balance. Etiologic factors can often be divided into physiologic and nonphysiologic (pharmacologic, pathologic, and idiopathic) causes. While the majority of gynecomastia is asymptomatic, some develop breast pain or may palpate a retroareolar mass. There have been psychosocial ramifications of patients including reduced self-esteem, mood disorders and body dysmorphic disorders. A thorough history and physical exam remain the mainstay for diagnosis. True gynecomastia is detected on physical exam as a mobile concentric disk of firm tissue beneath the nipple-areolar complex. Laboratory testing, imaging, and biopsy are not routinely required except in cases where pathologic etiology, including breast cancer, cannot be ruled out. The treatment of choice for most cases involves sympathetic reassurance and observation as the majority of cases self-resolve within a few years. Recurrence rates are highly variable dependent on etiology. Select patients may be considered for treatment with medication, radiotherapy and/or surgical management. Adequate planning and alignment of patient expectations are imperative for optimal patient satisfaction.