Diagnosis and Treatment of Gynecomastia

Diagnosis

If you visit a hospital with the above symptoms, the doctor will assess your symptoms after taking a detailed medical history, perform a physical examination such as visual inspection and palpation, and carry out an ultrasound examination.

1. Medical history The doctor checks the overall details, including when the symptoms began, how severe they are, past medical history, whether you are taking any medications, and your general health, and evaluates the severity of gynecomastia. The classification of gynecomastia is used not only to assess the patient’s condition before treatment, but also to evaluate the degree of response to treatment.

2. Physical examination Because breast tissue can be directly observed, the first step is to check whether there is any left-right asymmetry. While the patient is standing, the doctor directly palpates with their fingers and carefully observes the distribution, location, and shape of any lumps. Through this, it is possible to assess the size and firmness of gynecomastia, and in older patients it can also help to some extent confirm whether breast cancer is present, so this is an examination that must be performed in patients suspected of having gynecomastia.

3. Ultrasound examination An ultrasound examination is an imaging test that sends high-frequency sound waves, which cannot be heard by the ear, into the body and then electrically processes the sound waves reflected back from organs or tissues to display them as images on a monitor. Since the breast is anatomically located directly in front of the pectoral muscles, clear breast images can be obtained by placing the ultrasound device directly on the skin.

Breast ultrasound can accurately measure the size of the breast to determine the severity of gynecomastia, and at the same time confirm whether breast cancer, mastitis, or breast calcification is present, making it an essential test for diagnosing gynecomastia. On ultrasound, gynecomastia can be diagnosed clinically when there is more than 2 cm of breast tissue beneath the areola in the absence of obesity.

4. Female and male hormone tests Depending on the patient’s condition, it may be necessary to measure blood levels of male and female hormones through blood tests to differentiate whether the condition was caused by an abnormality in male or female hormones.

Treatment

There is no need to start treatment simply because the breasts are enlarged during puberty. However, in the following cases, active treatment for gynecomastia should be considered. However, when the enlargement is due to simple obesity without glandular tissue, surgery is performed for cosmetic purposes, so liposuction is mainly used, and in this case health insurance benefits cannot be received.

Cases in which treatment should be actively considered include when symptoms caused by gynecomastia interfere with daily life, or when gynecomastia becomes a significant social or psychological burden. The purpose of treating gynecomastia is to reduce the patient’s symptoms and prevent possible complications that may occur later.

To achieve these goals, the currently used treatment method is surgery, although in special cases medication may also be necessary. A plastic surgeon comprehensively considers the patient’s symptoms, general condition, degree of disease progression, and preferences to choose the appropriate treatment.

1. Surgical treatment · Direct vision gland excision · Pull-out method · Ultrasound liposuction · Endoscopic treatment

2. Medication therapy Medication therapy is a method of relieving the patient’s symptoms and reducing the enlarged breasts by taking medication. A representative treatment currently used is tamoxifen, an estrogen-blocking female hormone agent. The mechanism of action of tamoxifen is, first, to interfere with the effect of estrogen on breast tissue by binding to estrogen receptors in the breast tissue, and second, to increase testosterone secretion.

This medication is mainly used to reduce the effect on the breasts of primary cancers that abnormally secrete hormones, such as lung cancer, stomach cancer, and liver cancer. It is used at 20 mg or 40 mg per day in divided doses for 1 to 2 months, and several weeks to one month after use, the size of the lump and the pain disappear. However, side effects such as liver toxicity, leukopenia, and thrombocytopenia may occur, so close consultation with a specialist is essential.

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

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