ESSENTIAL FEATURES
• Hypertrophy of normal breast tissue
• Can be divided into 2 categories:
1. Pubertal hypertrophy (ages 13–17)
2. Senescent hypertrophy (older than age 50)
EPIDEMIOLOGY
• Associated with some recreational and therapeutic drugs
–Marijuana
–Digoxin
–Thiazides
–Estrogens
–Phenothiazines
–Theophylline
CLINICAL FINDINGS
SYMPTOMS AND SIGNS
• Unilateral or bilateral breast enlargement
• Mass is subareolar, smooth, firm, and discoid
• Rarely painful, but patient may complain of vague breast discomfort
DIAGNOSTIC CONSIDERATIONS
• Frequently no identifiable cause
• Without pain, pubertal gynecomastia frequently regresses as the patient passes into adulthood
• Senescent gynecomastia may also regress spontaneously
• May represent local manifestation of systemic illness such as hepatic or renal insufficiency, or alterations in steroid metabolism
RULE OUT
• Carcinoma of the breast
WORK-UP
• History and physical exam
• Observation
• Biopsy of any dominant mass if concern for malignancy
TREATMENT AND MANAGEMENT
• Usually left untreated
• Dominant mass may be biopsied
SURGERY
Indications
• Failure of enlargement to regress and breast is cosmetically unacceptable
TREATMENT MONITORING
• Follow physical exam
RESOURCES
References
• Lazala C, Saenger P. Pubertal gynecomastia. J Ped Endocrinol Metab. 2002;15:553.
• Daniels IR, Layer GT. Gynaecomastia. Eur J Surg. 2001;167:885.
