 |
Gynecomastia: Enlarged
Male Breasts
Definition: Gynecomastia is a medical term that comes from the
Greek Words “woman-like breasts”, or enlarged breasts. It
is estimated to occur in 40 to 60 percent of men and may affect only one
breast or both. Though certain drugs and medical problems have been linked
with male breast overdevelopment, gynecomastia has a broad range of causes
that are classified as either physiological or pathological, although
in many cases no specific cause can be found. In true gynecomastia, the
breast enlargement is due to glandular breast tissue; in pseudogynecomastia,
the breast enlargement is secondary to fat accumulation; while both glandular
and fat tissue are present in mixed gynecomastia.
Correction: The surgical treatment of gynecomastia has two objectives:
reconstruction of the male chest contour, and histological clarification
of suspicious breast lesions. The age of the patient, consistency, grade,
and the presence of unilateral or bilateral breast development determine
the indication for surgery. Prior to surgical consult, the gynecomastia
patient should undergo a complete history and physical exam and appropriate
diagnostic testing to determine the underlying cause of the gynecomastia.
Physiologic gynecomastia occurs most frequently during times of male hormonal
changes, resulting from the effect of an altered estrogen/androgen balance
on breast tissue or from the increased sensitivity of breast tissue to
a normal estrogen level. In some cases, breast reduction may be performed
through less invasive procedures such as LipoSelection™.
• In adolescence: Pubertal gynecomastia is a common condition
with an overall incidence of 38 percent in males 10 to 16 years of age,
increasing to 65 percent at age 14, and dropping to 14 percent in 16 year
old boys. During adolescence, 75 percent of the gynecomastia cases are
bilateral but the breasts are often affected to different degrees. Pubertal
gynecomastia often regresses spontaneously in six months, 75 percent within
two years of onset, and 90 percent resolve within three years of onset.
The Gynecomastia Scale is adapted from the McKinney and Simon, Hoffman
and Kohn scales. Grade II Moderate breast enlargement exceeding areola
boundaries with edges that are indistinct from the chest. Grade III Moderate
breast enlargement exceeding areola boundaries with edges that are distinct
from the chest with skin redundancy present. Grade IV Marked breast enlargement
with skin redundancy and feminization of the breast.
• In adults: Gynecomastia is associated with increasing
age due to the progressive testicular hypofunction, an increase in body
fat, and an increase in the estrogen/androgen ratio. Pathological gynecomastia
is associated with both androgen deficiency and estrogen excess. Both
causes may be correlated to medications, diseases related to endocrinologic
abnormalities, tumors, chronic disease, chromosomal abnormalities, familial
disorders, and miscellaneous other conditions. While always a concern
when a mass is present, breast cancer accounts for only 0.2 percent of
all malignancies in male patients.
Source: American Society of Plastic Surgeons (ASPS
2004) and Dr. Daniel Man.
The American Society of Plastic Surgeons (ASPS) is the largest organization
of plastic surgeons in the world. ASPS represents physicians certified
by the American Board of Plastic Surgery (ABPS) or the Royal College of
Physicians and Surgeons of Canada. For reference, the following definitions
of cosmetic and reconstructive surgery were adopted by the American Medical
Association in 1989: Cosmetic surgery is performed to reshape normal structures
of the body in order to improvea patient's appearance and self-esteem.
Dr. Daniel Man's office is located directly across from Boca Raton Community
Hospital at 851 Meadows Road, Suite 222, Boca Raton, Florida 33486, phone
number 1-800-232-5508. |
