Enlargement Of Male Breast Research Articles

Unilateral breast enlargement in males during adolescence (10-19 years): Review of current literature and personal experience.

Idiopathic unilateral breast enlargement (UBE) in males is a, commonly overlooked, diagnosis of exclusion that requires careful history, meticulous physical examination, and pertinent laboratory studies to exclude the possible pathologic causes. The aims of the present update are to review the current literature on UBE in subjects during adolescent age (10-19 years) in 18 cases, and to report the personal experience in 13 adolescents referred to our unit during the last four decades. In total, our survey and personal experience include 31 UBE cases, 10 of whom (32.2 %) being idiopathic or familial gynecomastia (GM). In 3/31 (9.6%) UBE was due to breast sarcoma/ carcinoma; one patient (11-years old) had a 5-year history of painless lump in the right breast, which increased gradually in size followed by bloody nipple discharge. In the personal cases of 13 adolescents, a moderate to marked UBE was secondary to: treatment with androgens (2 β-thalassemic patients with hypogonadism), high estrogen/androgen ratio in 2 Klinefelter syndrome patients, peripheral aromatization of androgens in 1 patient with non-classical 21-hydroxylase deficiency (NC-21-OH-D). One patient had subareolar hematoma due to injury. In 2 patients (15,3%) marked UBE was due to cystic lymphangioma (histologically proved). Furthermore, 5 patients were characterized as idiopathic UBE In clinical practice, the persistence of UBE for long period before diagnosis necessitates attention and further evaluation. Underlying causes should be treated, when possible, while surgery can be offered to patients with persistent or atypical signs and/or symptoms of UBE. For the optimal management of this condition, better collaboration between primary care physician and specialists is mandatory.

Surgical management of gynaecomastia by using cross chest liposuction and limited periareolar incision for gland excision: an interesting case report

Gynaecomastia is excessive or abnormal enlargement of male breast tissue. It is one of a common problem among young men. The term gynaecomastia means female like enlargement of male breast due to increase ductal tissue, stroma or fat. Most common cause of gynaecomastia is idiopathic. Surgical treatment of gynaecomastia involves liposuction and glandular excision and in few cases skin excision. Here author presents a case of 24 years old young healthy male with Simon’s grade 2B bilateral gynaecomastia. He had stubborn fat over bilateral chest which was resistant to exercise. Gynaecomastia was mixed type in characteristic having adipose tissue as well as glandular tissue enlargement. Bilateral liposuction and glandular excision by limited periareolar incision under general anesthesia as a day care procedure was done. In our procedure we used Cross chest liposuction. Patient was discharged at the same evening without any complications. After four months of follow up patient has male pattern chest with almost invisible scar and intact Nipple areolar complex (NAC) sensation.

A Challenging Case of Gynecomastia

Gynecomastia is a benign enlargement of male breast; many techniques have been described for management but none have gained universal acceptance. In this article, we have described a challenging case of gynecomastia, which benefited from mastectomy, mastopexy and nipple reduction surgery, and we compare it with other therapeutic options in terms of complications and aesthetic outcome.

Isoniazid Induced Unilateral Gynecomastia: A Rare Case Report

Gynecomastia refers to glandular enlargement of male breast. It can be physiological, pathological, pharmacological and idiopathic. The present case report describes a case of isoniazid induced gynecomastia. Keywords: Gynecomastia, antitubercular treatment (ATT), isoniazid.

The effect of Tamoxifen on Patients with Gynecomastia

Purpose Gynecomastia is the most common cause of male breast enlargement and is a disease which can occur in men of all ages. The purpose of this study was to evaluate the effect of tamoxifen on size reduction of breast tissue in gynecomastia patients, regardless of age and symptoms. We also, aimed to investigate the advantages and disadvantages of tamoxifen compared to surgery and other medications. Methods Twenty patients diagnosed with gynecomastia at the Breast and Thyroid Surgery Department, of Wonkwang University Hospital from January 2013 to February 2019 were included. All patients received tamoxifen 20 mg once a day or 10 mg twice a day; two months of treatment was planned, and medication was administered. The diameter and depth of the gynecomastia tissue were followed up with breast ultrasound before and after treatment. A survey of age, nationality, location, symptoms, duration of symptoms, previous history, and causes was also conducted. Results Breast tissue size was measured by ultrasound when the gynecomastia patients first visited and after using tamoxifen. As a result, mean diameter decreased by 41.9%, mean thickness decreased by 41.0%, and estimated mean volume decreased by 74.3%, except for one patient with recurrence. No side effects of tamoxifen were found in this study. Conclusion Since tamoxifen treatment has few side effects and recurrence is rarely reported at the time of discontinuation, it is a good primary treatment. But secondary treatment should be considered if there is no subsequent reaction. Surgical treatment may also be considered for gynecomastia patients with Tanner’s breast stage higher than 4, or who want an immediate reduction in breast size. Keywords: Breast; Gynecomastia; Tamoxifen

Gynecomastia, as an Extremely Rare Presentation of Chest Wall Lymphoma: A Case Report and Review of the Articles

Male breast enlargement as gynecomastia may be as a sign of underlying systemic diseases. Male breast malignancy is also considered in differential diagnosis. We present a young man with primary chest wall lymphoma as gynecomastia, without pre-existing problem or other disease. Here, we present his clinical manifestation, management, and his early outcome. Chest wall lymphoma as an initial presentation of isolated chest wall mass in males is a rare clinical entity and its presentation as gynecomastia is even extremely unusual. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(4):276-279.

Causes and Metabolic Consequences of Gynecomastia in Adult Patients

Background Gynecomastia (GM) is a benign enlargement of male breast due to glandular tissue proliferation. GM is a symptom of systemic or local hormonal disturbances, which could be associated with functional changes or pathological conditions. However, the long-lasting steroid imbalance in men with GM might exert negative influence on their metabolic health. Methods A total of 110 adult men with symptomatic GM were included in the present retrospective cross-sectional study. Anthropometric, metabolic, and hormonal data of the patients were collected. Results In almost 64% of GM patients, the underlying pathological condition was identified. Moreover, the development of GM was among the primary symptoms leading to the proper diagnosis in more than 40% of hypogonadal patients. The prevalence of metabolic syndrome (MS) was 53%; the highest prevalence of MS was found in patients with medication-induced GM and in the hypogonadal patients, whereas the lowest prevalence was observed in men with idiopathic postpubertal GM despite the similar degree of obesity. The lower testosterone levels were associated with more unfavorable lipid profile in the GM patients. Conclusion The development of GM in adults might be an important symptom of an underlying gonadal disease. Moreover, it could be associated with an increased risk of metabolic disturbances. Our results support the need of detailed laboratory and hormonal investigations in patients with GM including targeted screening for metabolic disturbances. Further longitudinal studies are needed to evaluate the long-term consequences of sex hormones imbalance on cardiovascular morbidity and mortality in adults with GM.

Horsegram Induced Gynecomastia

Gynecomastia is benign enlargement of male breast. It is caused by high estrogen to androgen ratio, attributable to various causes of estrogen excess or androgen deficiency. Herewith we report a case of gynecomastia in a middle aged man due to excess consumption of horse-gram, containing flavonoids which are estrogenic compounds. Gynecomastia regressed gradually after stopping horse-gram consumption, without any other medical or surgical interventions.

Management of Adolescent Gynecomastia: An Update.

Gynecomastia refers to an enlargement of the male breast caused by benign proliferation of the glands ducts and stromal components including fat. It is the most common form of breast swelling seen in adolescent males. During pubertal development, gynecomastia can develop as a result of transient relative imbalances between androgens and estrogens. Pubertal gynecomastia is self-limited in 75 to 90% of adolescents and regresses over 1 to 3 years. However it may cause significant psychological stress and depression in adolescents. For boys with persistent gynecomastia that is causing substantial tenderness or embarrassment a tailored approach of close follow-up and use of anti-estrogen drugs may be recommended. These drugs block the effects of estrogens in the body and can reduce the size of the breasts somewhat. It appears that pharmacological therapy of persistent adolescent gynecomastia is reasonable effective if given early in the course of the disease and more successful in cases with small or moderate breast enlargement. However, neither of these drugs is universally approved for the treatment of gynecomastia because the risks and benefits have not been studied completely. Surgical approach may be needed under special conditions for cosmetic reasons. In this update, we review the different published trials for managing adolescent gynecomastia. (www.actabiomedica.it)

Cryolipolysis for Targeted Fat Reduction and Improved Appearance of the Enlarged Male Breast.

Pseudogynecomastia refers to benign male breast enlargement due to excess subareolar fat. Standard treatment is surgical excision under general anesthesia, liposuction, or a combination of both. The safety and efficacy of cryolipolysis was investigated for nonsurgical treatment of pseudogynecomastia. Enrollment consisted of 21 males with pseudogynecomastia. Subjects received a first treatment consisting of a 60-minute cryolipolysis cycle, followed by a two-minute massage, and a second 60-minute cycle with 50% treatment area overlap. At 60 days of follow-up, subjects received a second 60-minute treatment. Safety was evaluated by monitoring side effects and adverse events. Efficacy was assessed by ultrasound, clinical photographs, and subject surveys. Surveys revealed that 95% of subjects reported improved visual appearance and 89% reported reduced embarrassment associated with pseudogynecomastia. Ultrasound showed mean fat layer reduction of 1.6 ± 1.2 mm. Blinded reviewers correctly identified 82% of baseline photographs. Side effects included mild discomfort during treatment and transient paresthesia and tenderness. One case of paradoxical hyperplasia (PH) occurred but likelihood of PH in the male breast is not believed to be greater than in any other treatment area. This study demonstrated feasibility of cryolipolysis for safe, effective, and well-tolerated nonsurgical treatment of pseudogynecomastia.

Severe gynaecomastia associated with spironolactone treatment in a patient with decompensated alcoholic liver cirrhosis – Case report

Gynaecomastia is unior bilateral breast enlargement in males associated with benign hyperplasia of the glandular, fibrous and adipose tissue resulting from oestrogen-androgen imbalance. Asymptomatic gynaecomastia is a common finding in healthy male adults and does not have to be treated, while symptomatic gynaecomastia might be the symptoma of many pathological conditions and requires meticulous diagnosis and therapeutic management. The commonest causes of gynaecomastia in the Polish population include liver cirrhosis and drugs used to treat its complications. The current study presents the case of severe painless gynaecomastia in a patient with decompensated alcoholic liver cirrhosis, treated with spironolactone because of ascites. Breast enlargement assessed a IIb according to the Simon’s Scale or III according to the Cordova-Moschella classification, developed slowly over the two-year period of low-dose spironolactone therapy The course and dynamics of disease are described and the main mechanisms leading to its development discussed. The importance of effective treatment of patients with severe gynecomastia is emphasized as the disease may result in significant psychosocial problems.

Surgical Treatment of Gynaecomastia: A Prospective Study in 75 Patients

Introduction: Gynaecomastia is a benign enlargement of male breast; many techniques have been described for management but none have gained universal acceptance. We discuss the outcomes of the surgical management of gynaecomastia and assess the morbidity and complication rates associated with the procedure to determine whether certain surgical techniques produce better outcomes. Materials and Methods: 75 patients with gynaecomastia were operated in our hospital during the period from Jan. 2009 to Jan. 2015. Results: A total of 140 breasts were operated on during the study period. Patients underwent either liposuction alone (20 breasts), excision alone (70 breasts), both excision and liposuction (36 breast) or skin reduction procedure (14 breasts). 19 operated breasts (13.4%) experienced some form of complications. Minor complications included seroma (4 patients), superficial wound dehiscence (3 patients) and two patients developed haematomas requiring evacuation in theatre. Unsatisfactory cosmotic result was present in 10 breasts and surgical revision was done in 5 breasts. Simon grade 111 breasts experienced the highest complication rate. Conclusion: The study has found that moderate sized gynaecomastia whether true or pseudo gynaecomastia with mild to moderate breast redundancy can be managed easily and effectively by liposuction alone or combined with glandular resection while the conventional infraareolar subcutaneous mastectomy still gives satisfactory results and with no need to remove extra skin. On the other hand, large gynaecomastia with severe breast redundancy can be treated effectively by the inferior pedicle technique without vertical scar.

Genetic variants of estrogen beta and leptin receptors may cause gynecomastia in adolescent

Gynecomastia is a benign breast enlargement in males that affects approximately one-third of adolescents. The exact mechanism is not fully understood; however, it has been proposed that estrogen receptors and aromatase enzyme activity may play important roles in the pathogenesis of gynecomastia. While many studies have reported that aromatase enzyme (CYP19) gene polymorphism is associated with gynecomastia, only one study has shown a relationship between estrogen receptor (ER) alpha and beta gene polymorphism and gynecomastia. Thus, the aim of this study was to evaluate the relationships between CYP19 (rs2414096), ER alpha (rs2234693), ER beta (rs4986938), leptin (rs7799039), and leptin receptor (rs1137101) gene polymorphisms and gynecomastia. This study included 107 male adolescents with gynecomastia and 97 controls. Total serum testosterone (T) and estradiol (E2) levels were measured, and DNA was extracted from whole blood using the PCR-RFLP technique. The polymorphic distributions of CYP19, ER alpha, ER beta, leptin and leptin receptor genes were compared. The median E2 level was 12.41 (5.00-65.40) pg/ml in the control group and 16.86 (2.58-78.47) pg/ml in the study group (p<0.001). The median T level was 2.19 (0.04-7.04) ng/ml in the control group and 1.46 (0.13-12.02) ng/ml in the study group (p=0.714). There was a significant relationship between gynecomastia and leptin receptor rs1137101 (p=0.002) and ER beta receptor rs4986938 gene polymorphisms (p=0.002). According to our results, increased E2 level and ER beta gene rs4986938 polymorphism might explain why some adolescents have gynecomastia. Leptin receptor gene rs1137101 polymorphism might affect susceptibility to gynecomastia.

Laser-assisted lipolysis in the treatment of gynecomastia: a prospective study in 28 patients

Gynecomastia is the most common breast pathology. Numerous excisions and liposuction techniques have been described to correct bilateral male breast enlargement. Recently, there has been a shift from the open approach to minimally invasive techniques. This article reports a 5-year experience using laser-assisted lipolysis (LAL) to treat gynecomastia, and describes the surgical technique. Between January 2006 and December 2010, a total of 28 patients with bilateral gynecomastia were treated with LAL. Patients had a mean age of 36.5 years (range 24 to 56 years). LAL was performed with a 980-nm diode laser (continuous emission, 15 W power, 8-12 kJ total energy per breast) after tumescent anesthetic infiltration. The breast was evaluated objectively by two physicians who compared chest circumference and photographs. Patients were also asked to score the results using a visual analogue scale: 75 to 100 (very good), 50-74 (good), 25 to 49 (fair) and 0 to 24 (poor). The postoperative period for all patients was incident-free. After 6 months, 18 patients (64.3%) scored the results as "very good", 6 as "good" (21.4%), 3 as "fair" (10.7%) and 1 "poor" (3.6%). Mean chest circumferences pre- and postoperatively were, respectively, 117.4 ± 11.1 cm and 103.3 ± 7.5 cm (p < 0.001), corresponding to a mean difference of 14.1 cm. Physicians scored the photographs as "very good" in 22 patients (78.6%), as "good" in five patients (17.9%), and as "fair" in one patient (3.6%). LAL in gynecomastia is safe and produces significant effects on fatty tissue, with a reduction in breast volume, together with significant skin tightening. Provided an appropriate amount of energy is delivered by an experienced operator, the results are both significant and consistent.

A rare case of unilateral gynecomastia during antituberculous chemotherapy with isoniazid

Gynecomastia refers to enlargement of male breast (s) due to benign proliferation of glandular tissue and is caused by excessive estrogen. The etiology may be pathological, pharmacological, or idiopathic reasons. The present report describes a case of gynecomastia due to isoniazid therapy.

Listing By Interests

Gynecomastia is a common and sometimes distressing condition that may occur in males of all ages. Although most cases have benign causes and many are self-limited, male breast enlargement may also be a sign of underlying systemic disease or drug toxicity. Although rare, male breast cancer must also be considered in the differential diagnosis. A careful diagnostic evaluation should be pursued, tailored to the individual patient's circumstances. Treatment may include reassurance, medication, or surgery.

Approach to the Patient with Gynecomastia

Gynecomastia is a common and sometimes distressing condition that may occur in males of all ages. Although most cases have benign causes and many are self-limited, male breast enlargement may also be a sign of underlying systemic disease or drug toxicity. Although rare, male breast cancer must also be considered in the differential diagnosis. A careful diagnostic evaluation should be pursued, tailored to the individual patient’s circumstances. Treatment may include reassurance, medication, or surgery.

How Important Is “Pseudogynecomastia”?

“If male breast enlargement is caused by glandular proliferation, it is defined as gynecomastia. If it is caused by increased fat deposition, it is defined as pseudogynecomastia [1].” “Pseudogynecomastia is an ideal condition for ‘liposuction alone’, whereas gynecomastia can be treated by surgical excision, liposuction, or a combination of both.” These quotes seem to represent the current beliefs of the medical fraternity about enlarged male breasts. Presumably based on such beliefs, patients are advised to undergo radiologic investigations such as ultrasound scanning, mammography, contrast-enhanced computed tomography (CT scan), and magnetic resonance imaging (MRI) to differentiate pseudogynecomastia from gynecomastia. Moreover, these patients are treated by applying liposuction alone for pseudogynecomastia and surgical excision for gynecomastia. Some surgeons routinely apply liposuction alone to treat both gynecomastia and pseudogynecomastia patients. However, they likely have encountered some patients who have a partial recurrence of breast enlargement a few months after liposuction [2–4]. In addition, a close look at published “satisfactory” results of treatment using “liposuction alone” shows some breast enlargement remaining in some patients, irrespective of whether they had pseudogynecomastia or gynecomastia preoperatively. Liposuction alone, indeed, is a simple procedure for the treatment of enlarged male breasts. However, some breast enlargement is known to return after the procedure for some patients. Neither the cause nor the prevention of this recurrence is known [4]. Excisional surgery for both pseudogynecomastia and gynecomastia, with or without added liposuction for contouring of the chest and upper abdomen, ensures flat chests and no partial return of breast enlargement [5]. Liposuction alone, however, can be applied for those patients with pseudogynecomastia or gynecomastia who are willing either to accept the possibility of some enlargement returning in their breasts after surgery or to undergo “touch-up” operations at a later date. Cosmetic surgery patients are concerned about the appearance of their breasts, not their contents. From an appearance point of view, pseudogynecomastia does not exist. The patients seek flat chests irrespective of whether their breasts contain glands or fat. Some of these patients are dissatisfied by the partial return of enlargement of their breasts after liposuction alone. The term “pseudogynecomastia” seems to be the culprit that misleads surgeons because it is used almost synonymously with the treatment method of applying liposuction alone. Avoidance of the term “pseudogynecomastia” could be doubly beneficial. On the one hand, radiologic investigations to differentiate pseudogynecomastia from gynecomastia could be drastically reduced [6, 7]. On the other hand, the incidence of residual gynecomastia resulting from “liposuction alone for pseudogynecomastia,” could be significantly reduced or even eliminated. The author has no intention to ignite a controversy but fondly hopes to block or break the chain of unnecessary radiologic investigations, diagnoses of pseudogynecomastia based on these investigations, treatment of pseudogynecomastia with liposuction alone, and the risk for resultant unhappy patients because of residual gynecomastia. The author humbly appeals to the medical fraternity to consider discouraging usage of the term “pseudogynecomastia,” at least until the causes of residual gynecomastia are elucidated, and measures to prevent residual gynecomastia after liposuction alone are established.

Evaluation of breast enlargement in young males and factors associated with gynecomastia and pseudogynecomastia

Gynecomastia is defined as a palpable enlargement of the mammary gland in males that is distinguishable from lipomastia. The aim of this study was to assess the prevalence and characteristics of different causes of breast enlargement in young males referred to our tertiary center, and evaluation of the factors associated with gynaecomastia. One hundred thirty-five male recruits aged 20-30years were enrolled in the study. A control group comprising 32 age-matched healthy individuals aged 20-25years was also studied. Idiopathic gynecomastia (IG) was diagnosed in 31 of 135 patients (23%) and Klinefelter' syndrome (KS) was diagnosed in 70 cases (52%). Patients with KS had significantly higher body mass index (BMI) and waist and hip circumference waist/hip ratio than the control group. FSH, LH and SHBG were significantly higher and DHEAS, free testosterone (fT) and total testosterone (tT) were lower in patients with KS than the control group. Anthropometric measurements revealed significant increase in body weight and BMI in patients with IG compared with healthy controls. FSH and LH levels were significantly higher in the patients with IG. Patients with pseudogynecomastia alone were not obese and hypogonadism was observed in 35.1% of patients. We concluded that gynaecomastia in young adult males is mostly because of KS or idiopathic in origin. IG seems to be the result of androgen resistance and in part increased aromatization because of increased adiposity. Symptoms or findings for hypogonadism must be evaluated carefully in patients with pseudogynecomastia. We also suggest that the presence of both gynecomastia and azoospermia necessitate further karyotypic analyses for KS.

Gynecomastia in adolescents

Gynecomastia is a common finding in adolescent men. The primary care provider should feel equipped to thoroughly evaluate this condition and to differentiate physiologic from pathologic breast enlargement. The present review focuses on the epidemiology, pathogenesis, evaluation, and treatment of gynecomastia during adolescence. While gynecomastia has long been attributed to an imbalance between estrogen and androgen concentrations, recent literature has begun to illuminate other potential mechanisms for breast development in adolescent men. Increased leptin levels, as well as human chorionic gonadotropin and luteinizing hormone receptors on male breast tissue, may play a role. Newer treatment strategies, such as the antiestrogen raloxifene, have shown promising results; however, further studies are needed to determine long-term efficacy. As a result of the limited pharmaceutical treatment options, many more adolescents are seeking surgical intervention. Gynecomastia is frequently encountered in the primary care setting. During adolescence, male breast enlargement is most often benign and rarely represents a pathologic mechanism. Careful attention should be paid to both the breast and testicular examination. A detailed history should include an inquiry regarding the use of illicit substances, anabolic-androgenic steroids, herbal products, and medications. The impact of gynecomastia on the adolescent's mental health should be assessed. A workup for pathologic causes is rarely required. Reassurance remains the standard of care for physiologic gynecomastia.