• Commonest condition affecting male breast
• Due to enlargement of both ductal and stromal tissue
• It is benign and often reversible
• Usually presents as unilateral non-tender breast enlargement

Aetiology

• Most cases are idiopathic
• Physiological causes are due to relative oestrogen excess
• Physiological causes
  • Neonatal
  • Puberty
  • Senile
• Pathological causes
  • Primary Testicular Failure
    • Anorchia
    • Klinefelter's Syndrome
    • Bilateral Cryptorchidism
    • Acquired Testicular Failure
    • Mumps
    • Irradiation
  • Secondary Testicular Failure
    • Generalised hypopituitarism
    • Isolated gonadotrophin deficiency
  • Endocrine Tumours
    • Testicular
    • Adrenal
    • Pituitary
  • Non-Endocrine Tumours
    • Bronchial carcinoma
    • Lymphoma
    • Hypernephroma
  • Hepatic Disease
    • Cirrhosis
    • Haemochromatosis
  • Drugs
    • Oestrogens and oestrogen agonists - digoxin, spironolactone
    • Hyperprolactinaemia - methyldopa, phenothiazines
    • Gonadotrophins
    • Testosterone target cell inhibitors - cimetidine, cyproterone Acetate

Management

• Reassurance that it is a benign and self-limiting condition
• Treatment of any underlying cause Surgery
• Cosmetic results of surgery can be disappointing
• Surgery can be considered if gynaecomastia is painful or cosmetically embarrassing
• Small areas of gynaecomastia can be excised through periareolar incision
• More extensive areas require either:
  • Liposuction
  • Breast reduction via circumareolar incision

Bibliography

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Colombo-Benkmann M, Buse B, Stern J, Herfarth C. Indications for and results of surgical therapy for male gynecomastia. Am J Surg 1999; 178: 60-63.
Daniels I R, Layer G T. Gynaecomastia. Eur J Surg 2001; 167: 885-892.
Fruhstorfer B H, Malata C M. A systematic approach to the surgical treatment of gynaecomastia. Br J Plast Surg 2003; 56: 237-246.
Gasperoni C, Salgarello M, Gasperoni P. Technical refinements in the surgical treatment of gynaecomastia. Ann Plast Surg 2000; 44: 455-458.
Glass A R. Gynecomastia. Endocrinol Metab Clin North Am 1994; 23: 825-837.
Williams T G Dawson P M. Gynaecomastia - presentation, aetiology and management. Current Practice in Surgery 1992; 4: 105 - 109.
Wise G J, Roorda A K, Kalter R. Male breast disease. J Am Coll Surg 2005; 200: 255-269.