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  • • Hypertrophy of normal breast tissue

    • Can be divided into 2 categories:

    • 1. Pubertal hypertrophy (ages 13-17)

      2. Senescent hypertrophy (older than age 50)

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Epidemiology

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  • • Associated with some recreational and therapeutic drugs

    • -Marijuana

      -Digoxin

      -Thiazides

      -Estrogens

      -Phenothiazines

      -Theophylline

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Symptoms and Signs

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  • • Unilateral or bilateral breast enlargement

    • Mass is subareolar, smooth, firm, and discoid

    • Rarely painful, but patient may complain of vague breast discomfort

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  • • Frequently no identifiable cause

    • Without pain, pubertal gynecomastia frequently regresses as the patient passes into adulthood

    • Senescent gynecomastia may also regress spontaneously

    • May represent local manifestation of systemic illness such as hepatic or renal insufficiency, or alterations in steroid metabolism

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Rule Out

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  • • Carcinoma of the breast

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  • • History and physical exam

    • Observation

    • Biopsy of any dominant mass if concern for malignancy

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  • • Usually left untreated

    • Dominant mass may be biopsied

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Surgery

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Indications

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  • • Failure of enlargement to regress and breast is cosmetically unacceptable

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Treatment Monitoring

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  • • Follow physical exam

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References

Lazala C, Saenger P. Pubertal gynecomastia. J Ped Endocrinol Metab. 2002;15:553.  [PubMed: 12014513]
Daniels IR, Layer GT. Gynaecomastia. Eur J Surg. 2001;167:885.  [PubMed: 11841077]

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