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Gynecomastia

 

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Gynecomastia is a benign enlargement of the male breast resulting from a proliferation of the glandular component of the breast. The condition can occur physiologically in neonates , in adolescents, and in the elderly. Gynecomastia is defined clinically by the presence of a rubbery or firm mass extending concentrically from the nipples. Although gynecomastia is usually bilateral, it can be unilateral. In adolescent boys the condition is often a source of distress, but for the large majority of boys whose pubertal gynecomastia is not due to obesity , the breast development shrinks or disappears within a couple of years. Some men and boys have fat on their chests that makes it look like they have breasts. Gynecomastia is a benign condition that accounts for 60% of all disorders of the male breast and 85% of male breast masses. It can occur in persons of any age, but 40% of cases occur in adolescent. As many as 65% of teenage boys have gynecomastia. Less commonly, gynecomastia may be caused by a hormone-secreting tumor of the breast, lung, or other organ. Careful history taking regarding the time of onset, family history, duration of enlargement, history of systemic illness, weight change, and drug or medication use, is important. Breast prominence can result from hypertrophy of either breast tissue or pectoral adipose tissue , and often a combination of the two. Breast prominence due solely to excessive adipose is often termed pseudogynecomastia.

Gynecomastia ( American English ) or gynaecomastia ( British English ) is the development of abnormally large breasts on males. It is a benign condition that accounts for more than 65% of male breast abnormalities. Gynecomastia is clearly differentiated from pseudogynecomastia, which is an accumulation of excess fat in a male breast. Gynecomastia affects an estimated 40 to 60 percent of men. It may affect only one breast or both. The procedure removes fat and or glandular tissue from the breasts, and in extreme cases removes excess skin, resulting in a chest that is flatter, firmer, and better contoured. The causes of common gynecomastia remain uncertain, although it has generally been attributed to an imbalance of hormones or the tissue responsiveness to them; a root cause is rarely determined for individual cases. This condition is called pseudogynecomastia (false gynecomastia) Estrogen production in males is mainly from the peripheral conversion of androgens (testosterone and androstenedione) through the action of the enzyme aromatase, mainly in muscle, skin, and adipose tissue in the forms of estrone and estradiol .

Causes of Gynecomastia

The common Causes of Gynecomastia :

  • Physiologic gynecomastia is seen in newborn infants, pubescent adolescents, and elderly individuals.
  • Chronic liver disease.
  • Pathologic gynecomastia can be caused by decreased production and/or action of testosterone, increased production and/or action of estrogen, or drug use; however, gynecomastia can also be idiopathic.
  • Exposure to androgen hormones.
  • Tumors.
  • Viral orchitis.
  • Genetic disorders.
  • Kidney failure.
  • Overactive thyroid (hyperthyroidism).
  • Side effects of some medications .

Symptoms of Gynecomastia

Some common Symptoms of Gynecomastia :

  • Depression.
  • Difficulty concentrating.
  • Irritability .
  • Fatigue.
  • Enlargement of the breasts with firm tissue, usually on both sides .
  • Constant pain in the breast are (either or both).
  • Tenderness.
  • Feminine looking breast.

Treatment of Gynecomastia

  • Apply cold compresses and use analgesics as recommended by the health care provider if swollen breasts are also tender.
  • If treatment of gynecomastia is needed, medications are sometimes used, though they can produce unwanted side effects.
  • Treatment with dihydrotestosterone, which cannot be aromatized to estrogen, has also been reported to cause significant symptomatic improvement in persons with gynecomastia.
  • Pubertal gynecomastia resolves spontaneously within several weeks to 3 years in approximately 90% of patients. Breasts greater than 4 cm in diameter may not completely regress.
  • For patients with idiopathic gynecomastia or residual gynecomastia after treatment of the primary cause, medical or surgical treatment may be considered.
  • If surgery is necessary for patients with lipomastia (ie, pseudogynecomastia), liposuction may be warranted.