eMedicine Specialties > Plastic Surgery > Breast

Gynecomastia: Workup

Author: Jay M Pensler, MD, Aesthetic Plastic and Reconstructive Surgery, Private Practice; Clinical Associate Professor, Department of Surgery, Division of Plastic Surgery, Northwestern University Medical School
Coauthor(s): Merle J Yost, BA, MA, LMFT, Licensed Marriage and Family Therapist
Contributor Information and Disclosures

Updated: Jul 1, 2009

Workup

Laboratory Studies

  • History and physical examinations are key elements used when considering the diagnosis of gynecomastia.12 Longstanding stable cases in an adult do not require blood tests other than those that would be required for an outpatient surgery. For routine outpatient surgery in healthy individuals aged less than 40 y, the authors do not require any laboratory testing prior to routine surgery.
  • Blood work should include liver function tests and assays for follicle-stimulating hormone, luteinizing hormone, human chorionic gonadotropin, thyroid-stimulating hormone, thyroxine, estrogen, estradiol, and testosterone levels in children and in individuals with progressive disease.

    Flow chart of the workup to determine the etiolog...

    Flow chart of the workup to determine the etiology of gynecomastia.

    [ CLOSE WINDOW ]
    Flow chart of the workup to determine the etiolog...

    Flow chart of the workup to determine the etiology of gynecomastia.

  • A sex chromatin study should be performed to exclude Klinefelter syndrome when appropriate.
  • Elevated estrogen and 17-ketosteroid levels in urine indicate the presence of a feminizing adrenal tumor.

Imaging Studies

  • If indicated by the patient's history, physical examination, and laboratory results, preoperative workup may include an ultrasound examination of the testes and breasts, computed tomography scan of adrenal glands, magnetic resonance imaging of sella turcica, and mammography when appropriate.

Other Tests

  • Excisional biopsy or fine-needle aspiration of breast tissue should be performed if a breast tumor is suspected.
  • Excised tissue should be sent for histological examination to exclude malignancy in appropriate cases. Approximately 1% of all primary breast tumors are reportedly found in men, and breast cancer accounts for 0.7% of all male cancers. As previously mentioned, unilateral cases with rapid progression should be viewed with suspicion.

Histologic Findings

  • Gynecomastia has 3 recognized pathological patterns.
    • The first type, the florid type, is characterized by an increase in the number and length of ducts, proliferation of ductal epithelium, periductal edema, a highly cellular fibroblastic stroma and hypervascularity, and the formation of pseudolobules. The florid type is the most common in patients with gynecomastia of less than 4 months' duration.
    • The second type, the fibrous type, is characterized by dilated ducts with minimal proliferation of epithelium, an absence of periductal edema, and an almost acellular fibrous stroma without adipose tissue. The fibrous type is the most common in patients with gynecomastia that lasts for 4-12 months.
    • The third type, the intermediate type, is an overlapping pattern of both the florid and the fibrous types.

Staging

  • Idiopathic gynecomastia is a benign condition.

More on Gynecomastia

Overview: Gynecomastia
Workup: Gynecomastia
Treatment: Gynecomastia
Follow-up: Gynecomastia
Multimedia: Gynecomastia
References
[ CLOSE WINDOW ]

References

  1. Devalia HL, Layer GT. Current concepts in gynaecomastia. Surgeon. Apr 2009;7(2):114-9. [Medline].

  2. Nydick M, Bustos J, Dale JH Jr, Rawson RW. Gynecomastia in adolescent boys. JAMA. Nov 4 1961;178:449-54. [Medline].

  3. Webster GV. Gynecomastia in the Navy. Mil Surg. 1944;95:375-9.

  4. Williams GM. Gynecomastia. N Engl J Med. Jul 15 1993;329(3):209. [Medline].

  5. Eckman A, Dobs A. Drug-induced gynecomastia. Expert Opin Drug Saf. Nov 2008;7(6):691-702. [Medline].

  6. Morrone N, Morrone Junior N, Braz AG, Maia JA. Gynecomastia: a rare adverse effect of isoniazid. J Bras Pneumol. Nov 2008;34(11):978-81. [Medline].

  7. Parker LN, Gray DR, Lai MK, Levin ER. Treatment of gynecomastia with tamoxifen: a double-blind crossover study. Metabolism. Aug 1986;35(8):705-8. [Medline].

  8. Parker S. A male breast lesion. Surgical-tutor.org.uk [online]. Available at: http://www.surgical-tutor.org.uk/core/neoplasia/gynaecomastia.htm. January 2, 2003;[Full Text].

  9. Pensler JM, Sliverman BL, Sanghavi J, Goolsby C, Brizio-Molteni L and Molteni A. Estrogen and Progesterone receptors in gynecomastia. Plas Reconstr Surg. 2000;106:1011-1013.

  10. Simon BE, Hoffman S, Kahn S. Classification and surgical correction of gynecomastia. Plast Reconstr Surg. Jan 1973;51(1):48-52. [Medline].

  11. Yost, M. Demystifying Gynecomastia: Men with Breasts. Vol 1. ISBN 0-9777199-0-1: Mens Health; 2006:1-122.

  12. Singer-Granick CJ, Granick MS. Gynecomastia what the surgeon needs to know. Eplasty. 2009;9:e6. [Medline].

  13. Teimourian B, Perlman R. Surgery for gynecomastia. Aesthetic Plast Surg. 1983;7(3):155-7. [Medline].

  14. Al Qattan M, Hassanain J. On the neglected entity of unilateral gynecomastia. Ann Plast Surg. 2005;55(3):255-7.

  15. Bembo SA, Carlson HE. Gynecomastia: its features, and when and how to treat it. Cleveland Clin J Med. 1994;71(6):511-7.

  16. Braunstein GD. Gynecomastia. N Engl J Med. Feb 18 1993;328(7):490-5. [Medline].

  17. Burke CW. Gynaecomastia. Practitioner. Aug 1982;226(1370):1403-10. [Medline].

  18. Georgiade GS, Georgiade NG, Riefkohl R, Barwick WJ, eds. Plastic, Maxillofacial and Reconstructive Surgery. 2nd ed. Baltimore, Md: Williams & Wilkins; 1996:877-82.

  19. Goldwyn RM, Cohen MN, eds. The Unfavorable Result in Plastic Surgery: Avoidance and Treatment. 3rd ed. Baltimore, Md: Lippincott Williams & Wilkins; 2001:663-73.

  20. Jayapaul M. Recurrent painful unilateral gynaecomastia-interactions between hyperthyroidism and hypogonadism. Andrologia. 2006;38(1):31-3.

  21. Jurkiewics MJ, Mathes SJ, Krizek TJ, eds. Plastic Surgery: Principles and Practice. Vol 2. St. Louis, Mo: Mosby; 1990:1119-36.

  22. Leibovitch I. Incidence and management of gynecomastia in men treated for prostate. J Urology. 2006;175(5):1962-3.

  23. Letterman G, Schurter M. Breast Gynecomastia. 1976.

  24. Persichetti P, Berloco M, Casadei RM. Gynecomastia. In: Miller SH, ed. Year Book of Plastic, Reconstructive and Aesthetic Surgery. Vol 107. St. Louis, Mo: Mosby Year-Book; 2001:948-54.

  25. Ravel R. Clinical Laboratory Medicine. 4th ed. St. Louis, Mo: Mosby Year-Book; 1994.

  26. Simon BE, Hoffman S. Breast Gynecomastia. 1976.

  27. Wiesman IM, Lehman JA. Gynecomastia: an outcome analysis. Ann Plast Surg. 2004;53(2):97-101.

  28. Wilson JD, Foster DW, Kronenberg HN, Larsen PR. Disorders of breasts in men. In: Wilson JD, Foster DW, eds. Williams Textbook of Endocrinology. 9th ed. Philadelphia, Pa: WB Saunders; 1998:885-93.

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

male breast enlargement, female-like breasts, feminization, male feminization, mastectomy, liposuction-assisted mastectomy, reduction mammaplasty, male breast lesion, male breast abnormality, male breast anomaly, feminized male breast, breast mass, male breast mass, congenital anorchia, Klinefelter syndrome, Klinefelter's syndrome, testicular feminization, hermaphroditism, hermaphrodite, adrenal carcinoma, adrenal cancer, liver disorder, hepatic disorder, liver disease, hepatic disease, malnutrition, testosterone deficiency, gynecomastia, ideopathic gynecomastia, surgical gynecomastia, glandular gynecomastia

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Jay M Pensler, MD, Aesthetic Plastic and Reconstructive Surgery, Private Practice; Clinical Associate Professor, Department of Surgery, Division of Plastic Surgery, Northwestern University Medical School
Jay M Pensler, MD is a member of the following medical societies: American Academy of Pediatrics, American Burn Association, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society for Laser Medicine and Surgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Chicago Medical Society, Illinois State Medical Society, International College of Surgeons, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Merle J Yost, BA, MA, LMFT, Licensed Marriage and Family Therapist
Disclosure: Gynecomastia.org Ownership interest Sole owner

Medical Editor

Pankaj Tiwari, MD, Assistant Professor, Division of Plastic Surgery, Ohio State University
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Saleh M Shenaq, MD†, Former Director and Founder, The International Brachial Plexus Institute; Former Chief, Section of Plastic Surgery, Methodist Hospital, Houston
Saleh M Shenaq, MD† is a member of the following medical societies: American Academy of Anti-Aging Medicine, American Academy of Pediatrics, American Association for Hand Surgery, American Association for the Advancement of Science, American Association of Plastic Surgeons, American Burn Association, American College of Physician Executives, American College of Surgeons, American Congress of Rehabilitation Medicine, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, American Society of Gene Therapy, American Society of Law Medicine and Ethics, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Trauma Society, Association for Academic Surgery, International College of Surgeons, Lipoplasty Society of North America, Plastic Surgery Research Council, Society for Neuroscience, Society of Surgical Oncology, Southern Medical Association, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Al Aly, MD, FACS, Consulting Surgeon, Iowa City Plastic Surgery
Disclosure: Ethicon  Consulting fee Consulting; QMP Royalty Book royalty; Insorb Stapler Consulting fee Consulting; Insorb Stapler Ownership interest None; Medicis Intellectual property rights None

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.