Gynecomastia

    Define gynecomastia.


Enlargement of the ductal, stromal, and adipose components of the male breast.


image    What is pseudogynecomastia?


Enlargement of the adipose tissue of the male breast; often seen in obesity.


image    In what three age distributions does gynecomastia peak?


Neonatal, pubertal, and adult.


image    What is the incidence of gynecomastia in each age group?


Neonates: 60% to 90%


Pubertal: 66%


Adults: 30% to 65%


Overall incidence is 35%.


image    What is the Simon classification of gynecomastia?


  I: Small but visible breast development, no skin redundancy.


IIa: Moderate breast development, no skin redundancy.


IIb: Moderate breast development with skin redundancy.


III: Severe breast development with large skin redundancy.


image    Name the hallmark location and clinic chest examination findings of gynecomastia.


Concentric mass directly beneath the nipple. Often described as a palpable, tender, firm, mobile, disc-like mound.


image    Name the three histopathologic classifications.


Florid—increase in vascularity and ductal tissues, early finding <4 months.


Fibrous—fewer ducts and stromal fibrosis, typically present after 1 year.


Intermediate—Mixture of the two as Florid transitions to Fibrous


image    What is the normal average areolar diameter in the male nipple areola complex?


25 to 30 mm.


image    What is the most common male nipple areola complex shape and location?


Oval and 20 cm from the sternal notch.


image    What is symptomatic gynecomastia?


Breast pain and tenderness.


image    What is the incidence and cause of newborn gynecomastia?


60%; transplacental passage of estrogens.


image    Name the four clinical etiologies of gynecomastia.


Physiologic (neonatal, pubertal, senescent),


Pathologic


Pharmacologic


Familial


image    What is pathologic gynecomastia?


Gynecomastia secondary to underlying disease, that is,


  adrenal tumors


  hypogonadism (acquired or congenital)


  tumors


  liver disease


image    How is familial gynecomastia genetically transmitted?


X-linked recessive.


image    What are the clinical characteristics of pubertal gynecomastia?


Glandular tissue is greater than 4 cm in diameter, resembling early female breast development.


image    What is the pathogenesis of pubertal gynecomastia?


Imbalance of androgen to estrogen ratio, often occurring in early puberty.


Commonly seen in midpuberty with Tanner stage 3 to 4 pubic hair and testicular volumes of 5 to 10 mL bilaterally.


image    What are the Tanner stages?


Tanner I


Male: Prepubertal genitalia


Female: Prepubertal genitalia, no glandular breast tissue; areola follows chest wall


Pubic Hair: Vellus pubic hair, no sexual hair


Tanner II


Male: Genital enlargement and change in skin texture


Female: Breast budding


Pubic Hair: Sparse, long, pigmented downy hair


Tanner III


Male: Growth in penile length and circumference


Female: Continued breast enlargement, no separation of contour


Pubic Hair: Darker, coarser, curlier


Tanner IV


Male: Penis enlarged in length and circumference. Enlarged testes


Female: Areolar and papillae elevation and secondary mound formation


Pubic Hair: Adult in quality but decreased distribution


Tanner V


Male: Adult genitalia


Female: Mature female breasts


Pubic Hair: Adult in quality, may spread onto medial thighs


image    What is the typical course of pubertal gynecomastia?


Self-limited in 75% to 90% of adolescents, regressing over 1 to 3 years.


image    What is the pathogenesis of senescent gynecomastia?


Primary testicular failure resulting in hypogonadism, and increased adipose tissue, leading to increased production of estrogens by aromatase.


image    Which drugs are strongly associated with gynecomastia?


  Digoxin


  Estrogens


  Ketoconazole


  Cimetidine


  Spironolactone


  Flutamide


  Anabolic steroids


  Marijuana


image    What is the pathogenesis of drug-induced gynecomastia?


Administration of exogenous estrogens (i.e., prostate cancer hormone therapy, topical estrogen creams)


Reduction of serum testosterone (i.e., ketoconazole, alkylating agents)


Direct gonadal suppression, (i.e., chemotherapy agents)


Blockade of androgen action (i.e., cimetidine, spironolactone, marijuana)


image    Elevated levels of which gonadotropins lead to gynecomastia?


Luteinizing hormone (LH) and human chorionic gonadotropin (HCG).


image    How does primary testicular failure cause increased estrogen to androgen ratio and gynecomastia?

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Aug 28, 2016 | Posted by in Reconstructive surgery | Comments Off on Gynecomastia
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