Gynaecomastia

Gynecomastia is the benign enlargement of the breast tissue in males. It usually happens because of imbalance between testosterone( male sexual hormone) and estrogen( female sexual hormone).

It is common to have it in newborns where it is transient and subsides without any treatment. Second age group is the adolescent age group. Pubertal Gynecomastia also usually do not need any treatment and subsides gradually within 1-2 years. However it can cause a lot of psychological disturbances in this age group. As the peer group comments can make them embarrassed about it, these boys will avoid sports /wearing tight T-shirts /swimming etc for the fear of inviting the mockery of fellow colleagues. The third group is the old age. In this age group it is due to declining the levels of testosterone levels.

Many diseases/ hormonal alterations/ drugs can lead to Gynecomastia.

The patients usually present to us for pain in the breasts/ asymmetry of the chest/ increase in the size of areola. Apprehension about turning this into malignancy also drives them paranoid about it.The common causes that we encounter in our practice is the drug related( finasteride,dutasteride,LHRH analogues given for the prostate cancer,calutamide), followed by pubertal and idiopathic cases. Other causes that commonly cause Gynecomastia are liver cirrhosis, alcoholism( due to the presence of phytoestrogens in the alcohol),hyperthyroidism,hyperprolactinemia, some rare tumors like Leydig cell tumor of the testis etc.

As urologist and andrologist it is not uncommon to see patients with chronic renal failure p[resenting with Gynecomastia.This is due to testicular damage and hormonal alterations in the body.The atrophic testes due leading to hypogonadism can also lead to Gynecomastia.

When we see the patients ; we take a detailed history including drug history, comorbidities, sexual history.Examination is done to rule out any tenderness in the breast , any testicular lump or atrophy etc.

We perform routine hematological and biochemical tests.The other special tests that we carry out is - hormonal profile, renal function test,liver function tests.

We routinely perform USG of the breast.The Gynecomastia is because of the enlargement of the glandular tissue.Whenever the physical examination or the ultrasound raises any doubt we go for the FNAC to rule out male breast cancer.

Treatment in pubertal /infantile and drug related cases is purely watchful waiting. But if there is tenderness then we add testolactone or tamoxifen ( dosage 10 mg twice a day for 3 months).The effect and the outcome of the medical line of management is not very optimistic however we have got good results as far as pain is considered.

In cases of prostate cancer if the tenderness is quite disturbing then we have tried chest radiotherapy.It leads to fibrosis and involution of the glandular component leading to reduction of the size and the pain too.

In cases of hyperprolactinemia we refer the patients to Endocrinologist to rule out any pituitary disorders.

Surgical treatment is resorted in recalcitrant cases. Various surgical alternatives are subcutaneous mastectomy , Liposuction, Laser assisted liposuction etc. The main aim is to remove the glandular component.

Extreme diet and weight reduction can prove to be counterproductive as the fat component can get reduced leading hanging of the skin which can be cosmetically more disappointing for the patient.