Definition: Gynecomastia is a medical term that comes from the Greek Words “woman-like breasts.” It is estimated to occur in 40 to 60 percent of men and may affect 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; and 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, 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 resolved within three years of onset.

The Gynecomastia Scale is adapted from the McKinney and the 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 other miscellaneous 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 improve a patient’s appearance and self-esteem.

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