Gynecomastia

Abstract

Gynecomastia is a benign enlargement of the breast attributable to proliferation of the ductal elements and that is usually self-limited. Its prevalence ranges from 24-65% when asymptomatic, but when it is symptomatic, this is markedly lower. It occurs as a result of metabolic, endocrine, congenital, or acquired hypogonadal disorders, producing increased estrogenic secretion, decreased testosterone synthesis, and less androgen sensitivity. The treatment of gynecomastia depends upon its etiology, duration, severity, and the presence of pain, and it is a multidisciplinary problem that requires endocrinological, surgical, oncological, and psychological management. Observation is the best approach, with reevaluation in men with drug-induced gynecomastia or with an underlying, treatable disorder such as hypogonadism or hyperthyroidism. If the gynecomastia persists for >3 but <6 months, administration of Tamoxifen is justified. Finally, if gynecomastia persists for >1 or 2 years, surgery is the best option because the breast tissue has probably become fibrotic and unresponsive to drug therapy.