Gynecomastia Surgery- 2022

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Gynecomastia Surgery- 2022

Gynecomastia usually develops in phases. In the proliferative phase, which lasts several months, the mammary gland grows. The tissue proliferation can regress. In the subsequent fibrosing phase, the tissue hardens, which can no longer be reversed.

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How common is gynecomastia?

The frequency of physiological, i.e. not pathological, gynecomastia varies considerably depending on age:

It is 60 to 90 percent in early infancy and usually disappears within a few weeks after birth.
During puberty, it occurs from the age of ten to twelve years, but most frequently in up to 60 percent of 13 to 14-year-old boys; spontaneous remission in the next one to two years occurs in more than 40 percent of all those affected observed. Genital development with the formation of secondary sexual characteristics and physiological testicle growth is not affected and is normal.
The third peak of incidence is between the ages of 50 and 80, with 25 to 65 percent of men in this age group being affected.

How does gynecomastia develop?

What causes gynecomastia?

Gynecomastia is not an independent clinical picture, but is a symptom of a disturbed relationship between estrogens and androgens. The possible causes of this endocrine change are manifold. However, gynecomastia is a common, physiological normal variant in certain stages of life (in newborns, during puberty or in old age).

Pathological forms can have various causes:

Hormonal imbalance between estrogens and androgens: especially increased estrogen levels or effects or reduced androgen levels or effects;
Hormone-producing tumors of the testicles, adrenal glands, or pituitary gland (prolactinomas);
General diseases: e.g. liver cirrhosis, hyperthyroidism, obesity, renal insufficiency;
Drugs: e.g. spironolactone, cimetidine, ranitidine, omeprazole, ketotonazole, bicalutamide, finasteride, diazepam, nifedipine, digitoxin, captopril, enalapril, amiodarone, anabolic-androgenic steroids (AAS for doping purposes);
Drugs: e.g. alcohol, heroin, methadone, marijuana, amphetamines;
Environmental and dietary influences (rare): e.g. soy milk, soaps and shampoos with lavender or tea tree oil additives, phytoestrogens, isoflavones;
Mechanical influences: pressure, impact, friction (e.g. in the case of soldiers);
Genetic factors: e.g. chromosomal abnormalities in Klinefelter syndrome.

In many cases, however, the trigger is not found (idiopathic gynecomastia) or several factors play together.

What symptoms can occur?

Clinically, gynecomastia shows up as a mostly bilateral enlargement of the nipple and areola, including a glandular body that can usually be felt in strands, which is often painful to pressure. It can lead to subjective complaints such as a feeling of tenderness in the breasts and tenderness of the nipples, but it can also be completely symptom-free (asymptomatic).

How is the diagnosis made?

The aim is to differentiate between a physiological and a pathological gynecomastia, whereby the diagnosis of a physiological change in the breast always represents a diagnosis of exclusion. The anamnesis is aimed at the beginning and course of the symptoms, nutrition, alcohol or drug consumption, a precise list of the existing medication, various symptoms of an androgen deficiency or other diseases. A painful and rapid breast growth is rated as rather unfavorable. As part of the physical examination, the breast and genital region (to rule out a testicular tumor) including the local lymph nodes are palpated.

How is gynecomastia treated?

Not every gynecomastia needs treatment. The aim is to eliminate or treat causal factors. Physiological or idiopathic gynecomastia often resolves on its own. It only requires treatment if it causes pain or psychological distress for aesthetic reasons. Depending on the trigger, drug therapies (only in the reversible phase) or surgical procedures (for cosmetic correction) are available if gynecomastia has already existed for a longer period (six to twelve months) and is already fibrosed. A clinical psychologist, for example, can be consulted if there is a high level of psychological distress.