Gynecomastia is breast tissue or fullness in men. Breast fullness is common in adolescence. Usually it improves with time. If it does not, it can be socially difficult. True gynecomastia is a combination of glandular breast tissue, fat, and skin.
Obesity is the most common cause of gynecomastia / chest fullness in men. If the issue is only fat, not glandular tissue, it may be called “pseudogynecomastia” or “lipomastia.” Gynecomastia from fat tends not to have much droopiness or “ptosis,” the areola are normal sized, and it is easier to correct. Usually I correct this with simple liposuction. As the fat in the breast tends to be fibrous and tough, I prefer to use ultrasonic UAL liposuction in addition to traditional liposuction for fat removal. Many believe the ultrasonic energy also helps the skin retract better.
If it is true gynecomastia with a glandular component, there are other causes that need to be evaluated: puberty, anabolic steroids, marijuana use, genetic disorders and syndromes, chronic liver disease, tumors, and some medications.
True “physiologic” gynecomastia is thought to be due to an altered estrogen androgen balance or from increased sensitivity of the breast tissue to normal estrogen level. In puberty breast enlargement can occur in 60-70% of adolescents, with a median age onset of 14 years. Many of these patients will have the issue resolve spontaneously in an average of 18 months. If the tissue is painful, inactive fibrotic tissue (not proliferating), or is greater than 4 cm it is more likely to persist into adulthood.
True “pathologic” gynecomastia is associated with too much estrogen or too little androgen. This can be caused by
Gynecomastia is graded by severity.
GRADE II- moderate breast enlargement, exceeding areola boundaries. Edges indistinct from the chest
GRADE III- moderate breast enlargement, exceeding areola boundary. Edges are distinct. Skin redundant
GRADE IV- marked breast enlargement, skin redundancy, and feminization of the breast.
To treat gynecomastia with a glandular component, a combination of excision of the breast tissue with liposuction is done. If the areola is enlarged, its size can be reduced.
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