Gynaecomastia
Gynaecomastia is a benign enlargement of the male breast which may be tender and painful. The term gynaecomastia is from the Greek words “mastos” and “gynae” which mean breast and woman respectively. It is common in both adolescents and adults.
Men with breast lumps, or generalised breast swelling, breast pain and nipple discomfort are being seen in increasing numbers in specialist breast clinics. In the vast majority of cases there is no known cause and this is termed “idiopathic gynaecomastia”
It may reflect an underlying imbalance in hormone physiology in which there is an increased oestrogen action relative to androgen action at the breast tissue level.
Of men presenting with lumps many are elderly and may be on multiple medication. It is estimated that between 10 – 20% of men with gynaecomastia have this condition as a result of a side effect to prescribed medication.
A list of all drugs known to have gynaecomastia as a possible side effect is given in Lists 1, 2 and 3
Much more rarely gynaecomastia may be secondary to other abnormalities and these include kidney or liver disorders, chromosomal abnormalities or endocrinological disorders. More rarely still, tumours arising from the pituitary gland, lungs, adrenal glands and testes may produce hormones that can stimulate male breast tissue to grow and enlarge.
In the Breast Clinic management is primarily the exclusion of breast cancer or other tumours and in our Clinic is by formal triple assessment. Our policy is to ultrasound all breast lumps in men and to add mammography in those over 40. When results are equivocal or suspicious of malignancy patients undergo ultrasound guided core biopsy. Endocrine evaluation of gynaecomastia is rarely productive and such testing is best done very selectively.
Most patients with confirmed gynaecomastia require reassurance only, but where symptoms merit there are some drugs that have been shown to alleviate symptoms at least partially. Those that have been described include Danazol, Tamoxifen, Raloxifene, Testalactone and aromatase inhibitors.
Where all else fails surgery provides a further option and the procedure of choice should be considered with great care on an individual basis.
