About Gynecomastia

Overview

Gynecomastia is a condition in which one or both breasts are excessively developed, mainly in adolescent boys and older men, and it is the most common lesion seen in the male breast. Gynecomastia occurs mainly in 60–70% of adolescent boys, especially between the ages of 12 and 15. It is usually asymptomatic and often resolves spontaneously after 6 to 18 months.

Although there are no exact domestic data on gynecomastia in Korea, foreign statistics show that it can be seen in about 7% to as many as 35% of the population, and its incidence is increasing due to westernization and the rise in obesity. It usually occurs in otherwise healthy people, but in rare cases it can also appear as a symptom of an endocrine disorder, so if there are any unusual findings, it is necessary to check for abnormalities in the endocrine system.

In rare cases, it may also be a warning sign of chromosomal abnormalities (Klinefelter syndrome) or disorders of the testicles, adrenal glands, thyroid, pituitary gland, or liver, so special caution is required.

However, breast enlargement during adolescence is usually normal and typically disappears before the age of 20. Therefore, if it remains after the teenage years, it is advisable to treat it surgically. In healthy men with no endocrine abnormalities, surgical treatment is the only effective way to make gynecomastia into a masculine chest. Fat is usually removed by liposuction, and glandular tissue is removed by excision of the glandular tissue. For detailed surgical methods, it is best to consult a board-certified plastic surgeon thoroughly.

If the breasts develop before puberty or if a hard lump is felt only on one side, special tests, accurate preoperative evaluation, and postoperative histopathological examination are needed to rule out other conditions.

[ Causes of Gynecomastia ]

1. Physiological causes
2. Increased blood estrogen levels
3. Increased blood androgen levels
4. Medication
5. Systemic disease

[ Other differential diagnoses affecting the breast gland ]

1. Mastitis
2. Breast cancer

Symptoms

[ Main symptoms of gynecomastia ] · In most cases, there are no symptoms at first, but the breast volume may gradually increase. · The overall breast volume increases, and other conditions in which only part of the breast enlarges should be suspected. · After puberty, gynecomastia undergoes fibrotic changes, so it is felt as a hard lump around the nipple. · If the hard lump is severe, pressing it with a finger may cause tenderness.

[ When to visit a hospital ] If any of the above symptoms interfere with daily life or cause discomfort, it is best to consult a plastic surgeon. Also, because the above symptoms can occur not only in gynecomastia but also in mastitis, breast inflammation, breast cancer, and others, an accurate differential diagnosis is necessary. Meanwhile, if blood comes out of the nipple in older adults, they should visit a hospital immediately.

[ Classification of gynecomastia ]

1. Classification by histologic findings · Glandular type: when the mammary gland tissue of the breast is developed · Fat-glandular type: the most common form, in which both glandular tissue and fatty tissue are developed · Fatty type: when the fatty tissue of the breast is developed

2. Classification according to lipodystrophy and excess skin · Grade 1: mild breast enlargement without skin sagging · Grade 2a: moderate breast enlargement without skin sagging · Grade 2b: moderate breast enlargement with mild skin sagging · Grade 3: severe breast enlargement with marked skin sagging to the point that it is difficult to distinguish from a real female breast

So far, we have explained gynecomastia. In the next part, we will look at the diagnosis and treatment of gynecomastia.

Source: Korea Disease Control and Prevention Agency National Health Information Portal