Correction of 'Male breasts' - Gynecomastia

Gynecomastia is a condition in which unilateral or bilateral benign excessive breast development occurs in males; that is, the development of female-like breasts in males. This is often an embarrassing and psychologically troubling problem that prompts the patient to seek correction. Initially thought to be a rare con­dition with a reported incidence of 8 in 100,000 during World War II, more recent studies have reported an overall incidence of 32 % to 36%, even as high as 40% of men in an autopsy series, and 64.6% in adolescent boys. The incidence of bilateral involvement also varies in the literature. Bilateral disease occurs in 25% to 75% of patients. This wide variation probably stems from an increased appreciation of the psychological, physical, and social impact of the condition, as well as the lack of a clear and standardized definition within the plastic surgery and medical literature.

Causes

The cause of gynecomastia is multifactorial, but in many cases an identifiable cause is elusive. Most authorities attribute the condition to stimulation of breast tissue by excess circulating estrogens or estrogen-like substances. This has been the basis for recent attempts at medical therapy for gynecomastia. However, surgical removal of the hypertrophic breast tissue remains the gold standard of treatment.

Gynecomastia has many identifiable causes, although most often, an identifiable cause is not found (25%). Recent investigations have shown that it may involve a relative or absolute excess of estrogens, a decrease in circulating androgens, or a defect in androgen receptors. There is strong evidence for the estrogen-stimulating effects of breast tissue development as well as support for an inhibitory androgenic effect.  No clear cause has been suggested based solely on hormonal influences. Instead, most accept that its probably due to physiologic, pathologic, pharmacological, and unknown causes.

Physiologic gynecomastia can be further subdivided into neonatal, pubertal, and elderly periods. Circulating maternal estrogens transferred by the placental-fetal circulation are thought to contribute to excessive development of breast tissue in neonates. Because this is usually a self-limited process lasting from weeks to months, treatment is rarely indicated. Up to 65 % of adolescent boys often exhibit varying degrees of gynecomastia, which usually resolves over several months to years. The degree of breast enlargement can be so minor as to escape recognition unless the area is clinically palpated.