Gynecomastia refers to the benign enlargement, unilateral or bilateral, of the male breast due to an increase of:
- Adipose (fat) tissue,
- Glandular tissue,
- Fibrous tissue, or
- A combination of all three.
Gynecomastia is the most common breast lesion in males, accounting for more than 65% of breast disorders in men.
Gynecomastia may be associated with any of the following:
- An underlying hormonal disorder, for example, conditions causing an imbalance of estrogen or testosterone found in liver disease, kidney failure, genetic disorders, an endocrine disorder, or tumors;
- A side effect of certain drugs (prescription, over the counter, or illegal);
- Cancer treatments (chemotherapy or hormonal/androgen therapies or blockades);
- Steroid abuse;
- Obesity; or
- Specific age groups, such as:
- Newborns or neonates, due to action of maternal or placental estrogens;
- Adolescent or pubertal, which consists of transient or short term, regressing in two to three years and bilateral breast enlargement that can be tender; or
- Adult aging, related to the decreasing levels of testosterone and relative estrogen increases.
Some adolescents and adults have fatty tissue on their chests that gives the appearance of gynecomastia. This condition is called pseudogynecomastia or false gynecomastia. In some patients, symptoms of true mastitis can occur. The possibility of cancer must be considered with breast enlargement in the adult male, accounting for approximately 1% of all breast cancers in the United States. True pubertal gynecomastia is common, 38% in males 10 to 16 years of age, increasing or peaking to 65% at age 14 years, then decreasing at age 16 years. Generally, pubertal gynecomastia regresses within six months, 75% within two years, and 90% within three years.
The indications for treatment are dependent on the prolonged presence of breast enlargement in the male patient. The hypertrophy of the breast tissue usually causes the patient to have a somewhat feminine appearance. The enlarged breasts will often give distention and tightness to the breast, which can cause pain and discomfort. Treatment for underlying hormonal disorders may require cessation of drug therapy or weight loss. Adolescent gynecomastia may resolve with aging.
The Gynecomastia Scale, adapted from the McKinney and Simon, Hoffman and Kohn scales used in the 1970’s to assess levels of male breast enlargement, is recommended by the American Society of Plastic Surgeons to grade breast growth and is as follows:
Grade I: Unilateral breast nodular enlargement, minor but visible breast enlargement without skin redundancy.
Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest, with or without skin redundancy.
Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are distinct from the chest with skin redundancy present.
Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast.
Mastectomy for gynecomastia is a surgical procedure to remove breast glandular tissue from a male with enlarged breasts, similar to subcutaneous mastectomy procedure performed on a female patient. Liposuction-assisted mastectomy has become a popular method used for pseudogynecomastia. An ultrasound modality may or may not accompany the liposuction technique.