Gynecomastia is a benign enlargement of the male breast (usually bilateral but sometimes unilateral) resulting from a proliferation of the glandular component of the breast. It is defined clinically by the presence of a rubbery or firm mass extending concentrically from the nipples. Gynecomastia should be differentiated from pseudogynecomastia (lipomastia), which is characterized by fat deposition without glandular proliferation.

Signs and symptoms

A thorough history should be obtained that addresses the following:

• Age of onset and duration of the condition
 
• Any recent changes in nipple size and any pain or discharge from the nipples
 
• History of mumps, testicular trauma, alcohol use, or drug use
 
• Family history of gynecomastia
 
• History of sexual dysfunction, infertility, or hypogonadism
  

Physical examination should include the following:

• Thorough examination of the breasts, with attention to size and consistency
 
• Assessment for any nipple discharge or axillary lymphadenopathy
 
• Testing to differentiate between true gynecomastia and pseudogynecomastia
 
• Assessment of glandular tissue
 
• Examination of the testicles, with attention to size and consistency, as well as nodules or asymmetry
 
• Observation of any signs of feminization
 
• Checking for any stigmata of chronic liver disease, thyroid disease, or renal disease

Hematoma, lipoma, male sexual dysfunction, and neurofibroma can be included in the differential diagnosis.

Diagnosis

Patients with physiologic gynecomastia do not require further evaluation. Similarly, asymptomatic and pubertal gynecomastia do not require further tests and should be reevaluated in 6 months.

Patient education

Reassure patients with physiologic gynecomastia regarding the benign nature of their condition, and inform them that most cases spontaneously resolve. (See Prognosis.) Counsel patients regarding the various treatment modalities available for gynecomastia, and highlight the risks, adverse effects, success rates, and benefits of each modality.

Source: Medscape Online