Gynecomastia – what you need to know
Gynecomastia, or the benign development of male breast glandular tissue, is generally caused by an increase in estrogen, a reduction in testosterone activity, or a combination of drugs. Although it is a relatively common appearance in general care and is usually of benign origin, it can create significant concern in patients. A progressive strategy incorporating imaging and laboratory tests to rule out neoplasms and endocrinopathies may make diagnosing more cost-effective. Idiopathic gynecomastia is identified if the findings of all studies are consistent. This evidence is primarily observational and of poor quality.
Although breast cancer is uncommon in males, gynecomastia individuals frequently experience anxiety and seek medical attention, making this presentation rather prevalent in primary care settings. Diagnostic examination of these situations can be costly, requiring laboratory and radiographic tests; hence, a diagnostic methodology that allows for step-by-step evaluation may be cost-effective while reducing related patient concerns. This page discusses the pathophysiology of benign gynecomastia and the most systematic processes and causes. It presents a diagnostic algorithm to help diagnose and manage symptomatic patients in primary care settings.
The usual criterion therapy for gynecomastia is surgery. Subcutaneous mastectomy is the most often utilized procedure, which includes direct removal of the glandular tissue via a periareolar or transareolar route, with or without accompanying liposuction. Liposuction alone may be adequate if the breast enlargement is entirely attributable to extra fatty tissue and there is no significant glandular hypertrophy. In more difficult situations, skin excision is required.
In general, the surgical treatment produces good cosmesis and is well tolerated. Newer, less invasive techniques that require minimal surgical incision have recently emerged and may offer faster recovery and lower rates of local complications. Histologic analysis is recommended in true gynecomastia corrections because unexpected histologic findings such as spindle-cell hemangioendothelioma and papilloma may occur in 3% of cases.
The evaluation of gynecomastias can be complex. A stepwise approach that starts with careful history taking and physical examination may prevent the need for extensive work-up. Subsequent selective imaging and laboratory testing help exclude possible neoplasms and endocrinopathies. The etiology is usually benign.