Gynecomastia is defined as the concentrated and equal swelling of the mammary gland and peripheral fat in men.

Gynecomastia

Gynecomastia or man boobs is most common on both sides and is the most common male breast disorder. It is responsible for about 85% of the masses of the mammary gland in the male population. The appearance of this breast hypertrophy is highly correlated with age. In infancy and puberty it occurs with great frequency, while in childhood it is almost non-existent. Man boobs is usually a symptom of endocrine diseases, but it can also be due to a side effect of drugs or toxic substances. For these reasons it becomes necessary to obtain a detailed history and a thorough clinical laboratory examination. The importance of finding the culprit or exogenous factor is crucial.

Sometimes it is not possible to find the cause for breast hypertrophy, so we characterize it as idiopathic. The surgical treatment of the disease has a place mainly in the treatment of idiopathic gynecomastia. Depending on the age of its appearance, we distinguish it in neonatal, adolescent and adult gynecomastia.

Gynecomastia that occurs in newborns (Neonatal gynecomastia) has no pathological background. It is the result of the action of the mother’s estrogens on them, during their fetal life. It subsides automatically within a few weeks. Adolescent (Pubertal gynecomastia) is quite common and occurs in 40% of adolescents, between the ages of 13 and 17 years. It is usually bilateral and resolves after 12-24 months. Man boobs that persists into adolescence should be closely monitored. Only after investigation can it be characterized as idiopathic and this, because it can hide a serious underlying disease, such as a testicular or adrenal tumor.

Gynecomastia is most common on both sides and is the most common male breast disorder. It is responsible for about 85% of the masses of the mammary gland in the male population. The appearance of this breast hypertrophy is highly correlated with age. In infancy and puberty it occurs with great frequency, while in childhood it is almost non-existent. Man boobs is usually a symptom of endocrine diseases, but it can also be due to a side effect of drugs or toxic substances. For these reasons it becomes necessary to obtain a detailed history and a thorough clinical laboratory examination. The importance of finding the culprit or exogenous factor is crucial.

Sometimes it is not possible to find a causative agent for man boobs. Then we characterize it as idiopathic. The surgical treatment of gynecomastia has a place mainly in the treatment of idiopathic gynecomastia. Depending on the age of onset of gynecomastia, we distinguish between neonatal, adolescent and adult gynecomastia.

Neonatal gynecomastia, that occurs in newborns has no pathological background. It is the result of the action of the mother’s estrogens on them, during their fetal life. It subsides automatically within a few weeks. Breast hypertrophy is quite common and occurs in 40% of adolescents, between the ages of 13 and 17 years. It is usually bilateral and resolves after 12-24 months. Adolescent breast hypertrophy that persists into adolescence should be closely monitored. Only after investigation can it be characterized as idiopathic and this, because it can hide a serious underlying disease, such as a testicular or adrenal tumor.

Adult gynecomastia

Man boobs (Senescent gynecomastia) occurs mainly in people over the age of 50 and occurs more often unilaterally, preferably on the left side, without a clear pathophysiological explanation. Here, too, the swollen mammary gland usually resolves over a period of 12-24 months. If the gynecomastia persists beyond the aforementioned period and as long as the diagnostic investigation has been completed and endogenous or exogenous etiological factors have been ruled out – in the case of idiopathic gynecomastia – then, for psychological and cosmetic reasons, mainly, we can perform surgery.

True man boobs is caused by the effect of estrogen on the male gland. This occurs in diseases where there is either increased estrogen production or androgen deficiency or a combination of both. In the rather large category of these diseases we could selectively mention testicular tumors, Klinefelter syndrome, congenital hyperplasia, or adrenal tumors, paraneoplastic secretion of 8-H.C.G., cirrhosis of the liver as well as eating disorders.

Gynecomastia and medecines

Man boobs of medical etiology is not uncommon. Drugs with estrogenic action (ringworm, anabolic steroids, marijuana), as well as drugs that inhibit the action or synthesis of testosterone (cimetidine, ketoconazole, spironolactone, antineoplastic, diazepam) are often implicated. In addition, drugs that increase estrogen synthesis or act by hitherto unknown mechanisms (reserpine, theophylline, verapamil, antidepressants, furosemide) may be responsible for causing gynecomastia.

True Man boobs must be differentiated from false (Pseudogynecomastia). Pseudogynecomastia occurs in people with marked obesity, who show a large deposit of fat in the mammary gland. Finally, in the differential diagnosis of breast hypertrophy, tumors should always be considered. These are, neurinoma (rare) and most commonly breast cancer, which occurs in the elderly, in whom mammography is performed as a routine examination in the diagnostic approach of the disease.

Conclusions

In conclusion, every patient with male breast hypertrophy should undergo a detailed examination, in order to determine the cause – endogenous or exogenous – that causes it. In these cases the treatment is causal. Indication for surgical treatment is idiopathic gynecomastia, when it does not subside in 12-24 months from its appearance, as well as cases of pseudogynecomastia in obese people. In both cases, psychological and cosmetic reasons require surgery.

Related links

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