Overview of Gynecomastia in the Modern Era and the Leeds Gynaecomastia Investigation Algorithm

Abstract

Gynecomastia is a benign enlargement of male breast glandular tissue. At least a third of males are affected at some time during their lifetime. Idiopathic causes exceed other etiologies and relate to an imbalance in the ratio of estrogen to androgen tissue levels or end-organ responsiveness to these hormones. Assessment must include a thorough history and clinical examination, specific blood investigations and usually tissue sampling and/or breast imaging. Management consists of a combination of measures that may include simple reassurance, pharmacological manipulation, medical treatment or surgery. Hormone therapy may help to abort the acute proliferative phase of gynecomastia with a 30% response rate but should not be considered in chronic established cases. Surgical treatment may comprise simple liposuction for a predominant fatty component or direct excision when glandular tissue is predominant. The main aim is to control the patient's symptoms and to exclude other etiological factors.

Surgical Strategies in the Treatment of Gynecomastia Grade I-II: The Combination of Liposuction and Subcutaneous Mastectomy Provides Excellent Patient Outcome and Satisfaction

“…It can be found at autopsy in 40-55% of all men [1][2][3][4][5]. GM most often presents bilaterally, although it can occur asymmetrically.…”

GPR30 Gene Polymorphisms Are Associated with Gynecomastia Risk in Adolescents

“…The most important cause of gynecomastia is an imbalance between the actions of estrogen and androgen, and this imbalance can result from an absolute increase in estrogen production, a relative decrease in androgen production or a combination of the two [1,2,3,4]. Excess estrogen in men causes breast growth by inducing ductal epithelial hyperplasia, ductal elongation and ductal branching and by increasing the proliferation of periductal fibroblasts and vascularity.…”

“…Gynecomastia, which is the most common breast condition in males, is characterized by generalized enlargement of the breast tissue with the presence of a rubbery or firm mass extending concentrically and symmetrically from the nipple [1] accompanied by a histopathologically benign proliferation of glandular male breast tissue [2,3]. The most important cause of gynecomastia is an imbalance between the actions of estrogen and androgen, and this imbalance can result from an absolute increase in estrogen production, a relative decrease in androgen production or a combination of the two [1,2,3,4].…”

A Rare Presentation of Thyrotoxicosis: Gynecomastia

“…Jinekomasti toplumda sık görülen klinik bir durumdur ve prevelansı, çalışma popülasyonunun yaş aralığı ve kullanı-lan kriterlere göre değişkenlik göstermekle beraber %30-65 arasında bildirilmiştir (1) . Jinekomasti gelişi-mine neden olan ana faktör östrojen üretiminde artış veya androjen seviyesinde azalma ile seks hormon etkilerindeki balansın bozulmasıdır (2) .…”