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Gynecomastia

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Ginecomasty is the increase of volume of the breasts in men. This patient only has it on the left side and it was corrected through surgery.

Male breast augmentation is due to abnormal development of male mammary gland. This growth can take place during puberty due to the hormonal changes that take place during this period. It can also be due to hormonal disorders, drugs or other substances.

Breast volume increases, usually below areola, due to mammary glandular tissue hypertrophy. In some cases, galactorrhea or whitish fluid nipple discharge is observed. Pseudogynecomastia takes place when breast augmentation is only due to subcutaneous fat deposit.

In those cases, in which ginecomastia persists, especially in young people, it determines an aesthetic alteration with very important (complex) emotional repercussions.

Gynecomastia diagnosis is clear in male mammary volume increase although, it is often the person himself/herself who recognizes the alteration that in some cases can be painful.

It’s a relatively frequent syndrome that appears spontaneously in puberty, or is provoked by intake of certain legal drugs such as estrogens, corticoids, spironolactone, sulpiride, digoxin, cimetidine, neuroleptics, amphetamines, etc., or certain illegal drugs like cannabis.

Endocrinic causes, which are less frequent, are testicle tumors, genetic illnesses such as the Klinefelter syndrome, hyperthyroidism (10%). It also appears with hypophysary adenoma and sometimes, during acromegaly.

Idiopathic gynecomastias (without apparent cause) are detected in 75% of the cases in puberty. Spontaneous regression gynecomastias are not serious. It appears in 35% of new borns and goes together with placentary hormones. In older people, it is usually due to estrogen/testosterone imbalances following testosterone decrease.
It can also appear in hepatic cirrhosis, Parkinson’s disease, Wilson’s disease (excessive deposition of copper in the body), and following cranial traumatism or brain tumors.

As we have seen, the diagnosis is based, on the patient’s clinical history and surgeon’s exploration. Hormone determinations and lung radiography are vital to determine cause of gynecomastia. A mammography confirms the diagnosis and excludes presence of malignant tumor.

3024_paginaVarón de 16 años enviado por su endocrinólogo que sufre un aumento de las glándulas mamarias (Ginecomastia verdadera). El tratamiento consiste en la retirada de las mismas a través de una incisión en la parte inferior de la areola, y lipoescultura de la grasa de alrededor.

Treatment

En muchos casos, no es necesario un tratamiento, sea porque la ginecomastia es discreta, sea porque regresa de manera espontánea (es el caso de la ginecomastia de la adolescencia), o con la suspensión del tratamiento en el caso de una ginecomastia por diuréticos (por ejemplo).

Treatment is often not required since the gynecomastia can be descrete, or because it recedes spontaneously (case of gynecomastia in puberty), or due to treatment suspension in cases of gynecomastia caused by diuretics (for example).

Sometimes, it is necessary for the patient to undergo a symptomatic treatment, based on androgens, or to recur to surgery in cases of large breast size or important psychoemotional repercussions.

Treatment consists of gland extirpation through a small cut in the areola in cases of true gynecomastia (with mammary gland) or liposculpture to eliminate fat.

Treatment is usually carried out combining both techniques, under local anesthesia with sedation, and on an outpatient basis, that is, without hospitalization.