Gynaecomastia is enlarged male breast and is defined as nodular tissue in sub areolar area. About 40-60 % male have Gynaecomastia. Th incidence increases with age and above 70 years 70-80 % male have Gynaeconastia.
The main cause of enlarged male breast is increased Estrogen hormone in proportion to Testosterone hormone.
Medications- anti hypertensives, hormonal medications,
Use of Marijuana
The Enlarged male breast can be of two type
Predominant Fat tissue
Mostly fibrous and areolar tissue
Usually male breast is benign and nothing to be concerned but if the increase in size is sudden, unilateral, associated with hard fixed lump., dimpling of skin etc. then investigation should be done to rule out any cancer.
Usually Physical examination, Mammography, Hormonal profile if indicated should be done before deciding plan of treatment, Mammography can differentiate if the breast enlargement is because of fatty adipose tissue or more of fibrous tissue. In hormonal profile we look for serum Testosterone, Estrogen, DHEA, S- HBG, etc.
Treatment options depend on many factors from conservative plan to surgery depending on age, severity of enlargement and patient profile.
Conservative treatment - In puberty the Gynaecomastia can resolve spontaneously. So wait and watch policy can be used.
Medical treatment- If the breast enlargement is recent 3-4 months of anti estrogen therapy as T. Tamoxifen or aromatase inhibitors, T. Danazol etc can be tried. The medical treatment does not work if the growth is more than 6 month old.
Liposuction - This is best treatment if breast is full of fatty tissue and less fibrous. In this Tumescent technique is used- The breast is filled with fluid and fat is sucked with special cannulas. The incision and scar are not visible after some time. The patient is discharged on same day. The surgical results are quite impressive. The post operative complications can be mild pain, oedema, bruising, and rarely nipple necrosis can happen
Subareolar Excision of Breast Tissue- This involves giving incision at the dark skin margin of breast[ areola]. This is very effective for fibrous breast tissue.The scar of this incision is not visible. This procedure prevents recurrence of breast enlargement.
In most cases we combine both these procedures. This gives better results in long term amd the shape of breast is flat.
Recently endoscopic guided breast tissue excision and vacuum-assisted biopsy device [VABD ] is also being used.
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