Gynecomastia, men who have breasts, is defined by a benign uni or bilateral proliferation of mammary glandular tissue. This is the consequence of a hormonal imbalance characterized by an excess of estrogen at the expense of androgens. It is a common male pathology observed at any age. It can be responsible for serious psychosociological problems.
Pseudo-gynecomastia or adipomastia is a differential diagnosis. It is rather a breast hypertrophy caused by adipose excess without involvement of the mammary glandular tissue.
How to diagnose ?
The family doctor or endocrinologist interviews people for personal history, current medications, and similar cases in the family.
Through careful clinical examination, the characteristics of gynecomastia (uni or bilateral, painful or not, soft, firm or hard) are specified. Then we ask for further examinations; ultrasound mammography and hormonal assessment.
At the end of this step we eliminate a malignant pathology including an uncommon breast cancer but can be observed in humans and there is an adipomastia true gynecomastia.
What are the causes ?
Drug causes: Iatrogenic gynecomastia is the most common among etiologies. The list of responsible drugs is long and is cited as an example; some neuroleptics, allopurinol (used to treat hyperuricemia), spironolactone (indicated in the treatment of high blood pressure), cimetidine (gastric bandage) ... and drugs (hashish, marijuana ...).
Endocrine causes: hyperthyroidism ...
Paraneoplastic syndrome: in relation to certain tumors at the expense of kidneys, spits or liver ...
Genetic causes: klinefelter syndrome ...
Systemic disease: chronic renal failure, hepatic cirrhosis.
Other: Obesity, sexual or neurotic hyperstimulation of the nipple and pubertal breast thrust. The latter is very common, it occurs in adolescents (13-14 years on average), the spontaneous regression is traditional is the reason why the therapeutic abstention is the rule.
Idiopathic Gynecomastia: When no cause is found.
What is the treatement ?
The treatment is primarily etiopathogenic. That is to say it is necessary to treat the cause, to stop a drug or toxic involved, to treat hyperthyroidism,
The indications for surgery are idiopathic gynecomastia, the failure of medical treatment and the persistence of aesthetically inconvenient gynecomastia.
When it is that fat that develops, adipomastia, the treatment consists of a lipoaspiration by a micro incision under local anesthesia. Another non-invasive alternative has proven its effectiveness namely cryolipolysis. Its principle is to induce paniculate controlled cold to destroy the adipocytes (fat cells).
When it comes to true gynecomastia, we intervene by a small incision in the areola and we remove this hypertrophied mammary gland.
In both cases, complete with a tight elastic compression to prevent the appearance of edema, the consequences are simple in the vast majority of cases, the patient can resume normal physical activity.
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