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Review
. 2012;130(3):187-97.
doi: 10.1590/s1516-31802012000300009.

Gynecomastia: physiopathology, evaluation and treatment

Alfredo Carlos Simões Dornellas de Barros  1 , Marcelo de Castro Moura Sampaio
Affiliations
Review

Gynecomastia: physiopathology, evaluation and treatment

Alfredo Carlos Simões Dornellas de Barros et al. Sao Paulo Med J. 2012.

Abstract
in English, Portuguese

Gynecomastia (GM) is characterized by enlargement of the male breast, caused by glandular proliferation and fat deposition. GM is common and occurs in adolescents, adults and in old age. The aim of this review is to discuss the pathophysiology, etiology, evaluation and therapy of GM. A hormonal imbalance between estrogens and androgens is the key hallmark of GM generation. The etiology of GM is attributable to physiological factors, endocrine tumors or dysfunctions, non-endocrine diseases, drug use or idiopathic causes. Clinical evaluation must address diagnostic confirmation, search for an etiological factor and classify GM into severity grades to guide the treatment. A proposal for tailored therapy is presented. Weight loss, reassurance, pharmacotherapy with tamoxifen and surgical correction are the therapeutic options. For long-standing GM, the best results are generally achieved through surgery, combining liposuction and mammary adenectomy.

A ginecomastia (GM) é caracterizada pelo aumento do volume mamário em homens, provocada por proliferação glandular e depósito de gordura. É comum e pode ocorrer em adolescentes, adultos e idosos. O objetivo desta revisão é discutir a fisiopatologia, etiologia, avaliação clínica e terapia da GM. Um desequilíbrio entre estrogênios e androgênios é reconhecido como a condição fundamental para a determinação do quadro, podendo ser atribuído a fatores fisiológicos, tumores ou distúrbios endócrinos, doenças não-endócrinas, uso de drogas ou ser de causa idiopática. A avaliação clínica deve enfocar a confirmação diagnóstica, a procura de uma causa específica e a classificação em graus de gravidade para orientar o tratamento. Um roteiro de conduta individualizada é apresentado, variando entre perda de peso e explicações verbais, tratamento com tamoxifeno e correção cirúrgica. Para casos de GM persistente, os melhores resultados são obtidos em geral mediante abordagem cirúrgica, combinando lipoaspiração e adenectomia mamária.

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Conflict of interest statement

Conflict of interest: None

Figures

Figure 1.
Figure 1.. Microscopic findings of gynecomastia characterized by dense fibrous stroma and dilated ductules without lobules (hematoxylin and eosin, 200 x).
Figure 2.
Figure 2.. Grade I - Increased diameter and slight protrusion limited to the areolar region.
Figure 3.
Figure 3.. Grade II - Moderate hypertrophy of the breast with the nipple-areolar complex above the inframammary fold.
Figure 4.
Figure 4.. Grade III - Major hypertrophy of the breast with glandular ptosis and the nipple-areolar complex situated at the same height as or as much as 1 cm below the inframammary fold.
Figure 5.
Figure 5.. Grade IV - Major breast hypertrophy with skin redundancy, severe ptosis and the nipple-areolar complex positioned more than 1 cm below the inframammary fold.
Figure 6.
Figure 6.. Mammary adenectomy by means of periareolar incision for gynecomastia grade I.
Figure 7.
Figure 7.. Liposuction followed by mammary adenectomy for gynecomastia grade II.
Figure 8.
Figure 8.. Liposuction followed by double-circle incision mammary adenectomy for gynecomastia grade III.
Figure 9.
Figure 9.. Inverted T-shaped mammary resection with nipple-areolar complex migration for gynecomastia grade IV.
See this image and copyright information in PMC

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