Management of Gynaecomastia

Abstract

Abstract Gynaecomastia, the benign enlargement of the breast glandular tissue in a male, is a common clinical condition, caused in most instances by an imbalance between the breast stimulatory effects of oestrogen and the inhibitory effects of androgens. It is a normal physiological process in infancy, puberty, and senescence. A number of medications have been associated with gynaecomastia, as has several pathological conditions leading to increased oestrogen action or decreased androgen action. Gynaecomastia should be distinguished from pseudogynaecomastia, representing breast enlargement due to fat deposition and not glandular enlargement, and breast cancer through a careful breast examination. The cause of gynaecomastia may be elucidated through the history, general physical examination, and a few laboratory tests. Treating an underlying pathologic cause may lead to resolution of the gynaecomastia, especially if it is of short duration (less than 6 months). Otherwise, a trial of an antioestrogen such as tamoxifen may decrease pain, tenderness, and breast enlargement. Tamoxifen or breast radiotherapy may be used to prevent the development of gynaecomastia in men receiving hormonal therapy for prostate cancer. For chronic fibrotic gynaecomastia or gynaecomastia unresponsive to medical therapy or failing to spontaneously resolve over time, plastic surgical removal can give acceptable cosmetic results.