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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. |
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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.
Treatment
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. 
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