Gynecomastia

• • Hypertrophy of normal breast tissue

  • Can be divided into 2 categories:

  • 1. Pubertal hypertrophy (ages 13-17)

    2. Senescent hypertrophy (older than age 50)

Epidemiology

• • Associated with some recreational and therapeutic drugs

  • -Marijuana

    -Digoxin

    -Thiazides

    -Estrogens

    -Phenothiazines

    -Theophylline

Symptoms and Signs

• • Unilateral or bilateral breast enlargement

  • Mass is subareolar, smooth, firm, and discoid

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

• • 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

Rule Out

• • Carcinoma of the breast

• • History and physical exam

  • Observation

  • Biopsy of any dominant mass if concern for malignancy

• • Usually left untreated

  • Dominant mass may be biopsied

Surgery

Indications

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

Treatment Monitoring

• • Follow physical exam

References