What is gynaecomastia?

Gynaecomastia is an increase in the amount of breast gland tissue in boys or men. It is caused by an imbalance of the hormones estrogen and testosterone.

Gynaecomastia can affect one or both breasts, sometimes unevenly.

Pseudo gynaecomastia is an increase in fat but not gland tissue in male breasts. The two must be distinguished from the other. Accurate diagnosis is key.

It is commonly unilateral and although it may be seen at any age, it is commonly seen in five groups of males.

It may be :

• Physiological
• Pharmacological
• Pathological

1. New born babies: due to maternal oestrogen and only lasts for a few weeks.
2. Adolescent boys: due to hormonal imbalance, more often seen in obese adolescents. They should be reassured and encouraged to lose weight.
3. Older men as testosterone levels drop.
4. Medication side effects.
5. Body builders: in men taking supplements.

The management is primarily diagnosis. Adequate medical history and drug history is mandatory and physical examination should always include testicular examination.

Medication should not be stopped unless the treating physician is involved. If the mass is problematic and affecting quality of life, a surgical option should be offered.

Male breast cancer should be ruled out. 1% of all breast cancers occur in males. The principles of management are the same as for women.