Gynecomastia Treatment & Management

  • Author: George Ansstas, MD; Chief Editor: George T Griffing, MD   more...
 
Updated: Apr 16, 2012
 

Approach Considerations

Generally, no treatment is required for physiologic gynecomastia. Pubertal gynecomastia resolves spontaneously within several weeks to 3 years in approximately 90% of patients. Breasts greater than 4 cm in diameter may not completely regress.

Identifying and managing an underlying primary disorder often alleviates breast enlargement. If hypogonadism (primary or secondary) is the cause of gynecomastia, parenteral or transdermal testosterone replacement therapy is instituted. However, testosterone does have the potential to exacerbate gynecomastia through the aromatization of the exogenous hormone into estradiol.

For patients with idiopathic gynecomastia or with residual gynecomastia after treatment of the primary cause, medical or surgical treatment may be considered.

A major factor that should influence the initial choice of therapy for gynecomastia is the condition’s duration. It is unlikely that any medical therapy will result in significant regression in the late fibrotic stage (a duration of 12mo or longer) of gynecomastia. As a result, medical therapies, if used, should be tried early in the condition's course. The diagram below is a suggested treatment approach for patients presenting with breast enlargement.

Suggested algorithm for the management of gynecomaSuggested algorithm for the management of gynecomastia.
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Pharmacologic Therapy

With the administration of clomiphene,[19] an antiestrogen, approximately 50% of patients achieve partial reduction in breast size, and approximately 20% of patients note complete resolution. Adverse effects, while rare, include visual problems, rash, and nausea.

Tamoxifen, an estrogen antagonist, is effective for recent-onset and tender gynecomastia.[20] Up to 80% of patients report partial to complete resolution. Nausea and epigastric discomfort are the main adverse effects.[21]

Other drugs used, albeit less frequently, include danazol.[22] Danazol, a synthetic derivative of testosterone, inhibits pituitary secretion of LH and follicle-stimulating hormone (FSH), which decreases estrogen synthesis from the testicles.

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Breast Surgery

Reduction mammoplasty is considered for patients with macromastia or long-standing gynecomastia or in persons in whom medical therapy has failed.[1] It is also considered for cosmetic reasons (and for accompanying psychosocial reasons).[23, 24, 25, 26, 27, 28, 29]

More extensive plastic surgery may be required in patients with marked gynecomastia or who have developed excessive sagging of the breast tissue due to weight loss. If surgery is necessary for patients with pseudogynecomastia, liposuction may be warranted.

A Chinese study indicated that endoscopic subcutaneous mastectomy, without skin excision, could be an effective treatment for gynecomastia.[30] In a report on the procedure's use in 65 patients (125 breasts) with gynecomastia, grade IIB or III, the authors stated that only a few operative complications occurred, including 2 cases of partial nipple necrosis and 1 case of subcutaneous hydrops. They also reported that postsurgical chest contour was satisfactory in all patients and that no recurrences were seen during the 3- to 36-month follow-up period.

Complications of surgery include sloughing of tissue due to a compromised blood supply, contour irregularity, hematoma or seroma formation, and permanent numbness in the nipple-areolar area.

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Contributor Information and Disclosures
Author

George Ansstas, MD  Instructor, Department of Internal Medicine, Washington University School of Medicine

George Ansstas, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Michael Ansstas, MD  Resident Physician, Department of Internal Medicine, St Louis University Hospital

Disclosure: Nothing to disclose.

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Mark R Allee, MD Associate Professor, Department of Medicine, University of Oklahoma College of Medicine

Mark R Allee, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Mary Zoe Baker, MD Professor, Department of Medicine, Section of Endocrinology, Metabolism and Hypertension, University of Oklahoma College of Medicine; Medical Director, Medicine Specialty Clinic, General Medicine Clinic and Medicine Residents' Clinic, University of Oklahoma Physicians

Mary Zoe Baker, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American Chemical Society, and American College of Physicians-American Society of Internal Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

References

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Adolescent gynecomastia.
Prominent areolae with dense subareolar ductal tissue.
Suggested algorithm for the management of gynecomastia.
 
 
 
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