Case 40 Gynecomastia



Lauren O. Roussel and Rachel R. Sullivan

Case 40 Gynecomastia

Case 40 (a,b) A 21-year-old male presents for correction of the size and appearance of his breasts.



40.1 Description




  • Adult male with bilaterally symmetric, mildly enlarged breasts



  • Minimal excess skin



  • Protuberance of nipple-areola complexes (NACs)



  • Normal body habitus, without evidence of obesity



40.2 Work-Up



40.2.1 History




  • Onset of breast development



  • Changes to breasts over time



  • Presence of breast pain, breast enlargement, and nipple discharge



  • Recent weight changes



  • Personal history of diseases of the liver, adrenal glands, thyroid, or kidneys, HIV, and complete medical history; family history of breast cancer



  • Current and prior medications or drug use




    • Certain medications have been associated with gynecomastia (see Table 40.1)






































      Table 40.1 Medications associated with gynecomastia development

      Medication/Drug Class

      Examples

      Antacid medications

      Cimetidine, omeprazole, ranitidine


      Antiandrogens

      Finasteride, spironolactone


      Antibiotics

      Fluconazole, isoniazid, ketoconazole


      Cardiovascular medications

      Calcium channel blockers, digoxin, furosemide


      Chemotherapeutic agents

      Alkylating agents, methotrexate, vincristine


      Drugs of abuse

      Alcohol, amphetamines, heroin, marijuana, methadone


      Exogenous hormones

      Anabolic steroids, estrogen cream or oral estrogens, testosterone


      HIV medications

      		  

      Psychoactive medications

      Diazepam, haloperidol, risperidone, tricyclic antidepressants




40.2.2 Physical Examination




  • Breast examination




    • Identify if breast enlargement is due to fat or glandular hypertrophy




      • Pseudogynecomastia: Bilateral breast enlargement due to fat deposition without an increase in glandular tissue



    • Finding concerning for malignancy: Small, firm, eccentricity, chest wall fixation, nipple discharge, and skin dimpling



    • Tenderness: >70% of benign gynecomastia will have tenderness



    • Presence of dense fibrous tissue



    • Degree of skin excess, breast ptosis



  • Simon’s classification, based on degree of tissue and skin excess




    • Type I: Minor enlargement of breast without skin excess



    • Type II: Moderate enlargement of breast




      • Type IIA: Without skin excess



      • Type IIB: With minor skin excess



    • Type III: Breast enlargement with skin excess



  • Virilization: Feminizing characteristics, lack of normal male hair distribution, voice changes




    • Testicular examination



    • Thyroid examination



    • Abdominal examination




      • Evaluate for organomegaly, abdominal masses, and ascites

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Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 40 Gynecomastia

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