False gynecomastia in men. Gynecomastia in men - causes, symptoms, diagnosis, methods of treatment and removal

True gynecomastia is an increase in the glandular tissue of the mammary glands. It is typical for men, but also occurs in women. The chest increases in size up to 10 cm and acquires a semblance of roundness.

ICD code 10 - No. 62.

Often men are embarrassed to go to the hospital and end up in a state where they need to be treated.

Gynecomastia occurs in newborns, adolescents, or older men.

If the mother's sex hormones enter the baby's body with milk, then he develops temporary gynecomastia. Treatment is not provided. Symptoms disappear without a trace after 3-4 weeks.

During the period of hormonal adjustment, teenage boys are affected by female hormones. At the age of 14 to 17 years, the disease manifests itself. If untreated, gynecomastia does not go away on its own and progresses, but not always.

Adolescents have bilateral gynecomastia with swelling of the halo, breasts and increased sensitivity of the nipples.

In older men, on the contrary, the effect of testosterone subsides. Its deficiency in the body provokes the active work of estrogens and an increase in mammary glands. More common in obese men.

Peculiarities

There are two types of gynecomastia in men: false and true. Visually, when viewed or from a photo, they are barely distinguishable: the nipples and halos begin to blur, the hair on the chest falls out, and a rounded shape appears. The false type is characteristic of obesity, and all changes are associated with the deposition of fat around the breast, and does not require treatment.

The true type is characterized by an increase in the glandular tissue of the breast in men. It can be distinguished by palpation of the nipples, near which initial stages a slight induration is palpable. Both types can be combined, but externally expressive chest gives only false gynecomastia.

Causes

The basis of gynecomastia in men is always a disturbed metabolism of hormones. It can be provoked due to the following reasons:

• hormonal changes during adolescence and senility
• impaired testosterone production due to testicular tumors, gastrointestinal problems, lung or pancreatic cancer
• inflammation of the testicles or prostate adenoma
• an increase in the amount of the hormone prolactin with abnormalities in the functioning of the pituitary gland
• metabolic diseases: diabetes, obesity
• with cirrhosis of the liver, intoxication of the body, kidney problems
• prolonged fasting
• frequent chest injuries, burns, bumps, reaction to surgery
• uncontrolled treatment with drugs that affect the endocrine system
• drugs and alcohol - inhibit liver function and, as a result, disrupt the metabolism of steroid hormones (especially opiates), drugs also stimulate the secretion of prolactin
• genetic predisposition and increased susceptibility body to estrogen in men
• psychological trauma, cranial nerve damage, epilepsy and other mental disorders

Symptoms and manifestations

Clinical manifestations depend on how early the man came to the examination. First, the skin around the nipple becomes rougher, after the breast increases in size, sometimes there is discharge from the nipples.

What else is typical for gynecomastia in men:

• pigmentation and swelling of the areola
• nipple sensitivity
• tight clothes are uncomfortable
• bloody discharge from the nipples
• seal in the form of a "pea" or "bean"

Diagnostics

Methods for diagnosing gynecomastia are extremely simple - this is an examination and ultrasound, the appointment of blood tests. Examination should be carried out at the first symptoms: induration in the chest and general deterioration states.

self-examination

It is impossible for a man to visually determine whether there is gynecomastia or not. Pathology requires testing and instrumental examination. The maximum that can be detected is a seal in the chest, and note the atypical sensitivity of the nipples.

Doctor's examination

At the first appointment, the doctor collects the most detailed anamnesis of the man’s life and finds out the diseases of the next of kin, the patient’s lifestyle and bad habits. A thorough examination of the breast is carried out: they probe the seal, find out the localization, determine the mobility and cohesion with neighboring tissues, determine the number of seals and their size, find out the presence of separated fluid from the nipples, check the increase axillary lymph nodes.

The presence of symptoms of feminization in a man is determined: a change in the timbre of the voice, a change in the density hairline, examine the genitals, find out the size of the penis and testicles.

If a pathology is suspected, a man is sent for an ultrasound scan, where the type of gynecomastia is determined, the nearest tissues and the structure of the glands are examined.

Other types of diagnostics

Biopsy and mammography can clarify the diagnosis. Both studies are prescribed in order to differentiate the diagnosis and establish the form of the disease. A biopsy is the removal of a piece of tissue or cells to be examined.

In addition, blood tests are prescribed for the hormones prolactin and testosterone. With an increased level of the latter, ultrasound diagnostics of the testicles and computed tomography of the adrenal glands are performed. This allows you to track organic changes in structures.

Treatment

Treatment of true gynecomastia in men involves conservative and surgical intervention. Therapy depends on age:

• If a we are talking about a newborn child, then treatment is not provided. Pathology goes away on its own after a month. But in the absence positive dynamics consultation with a pediatrician is required.
• Gynecomastia in adolescents and older men requires the restoration of hormonal levels: a decrease in estrogen production against the background of an increase in testosterone. The drugs Testolactone, Clomiphene, Tamoxifen, Danazol are prescribed.

The main methods of treatment:

1. refusal of treatment with drugs that caused pathology
2. avoiding drug or alcohol use
3. workout pectoral muscles to strengthen them
4. normalization of hormonal levels
5. increased testosterone levels
6. breast contouring - when changing the natural shape
7. medicinal electrophoresis with iodine, mud and laser treatment

Medication treatment is justified only in the first stages of gynecomastia. Facilities traditional medicine fruitless. In the absence of a positive response to conservative therapy, an operation is prescribed to stop breast growth and remove a cosmetic defect.

Treatment of adolescents is based on the intake of injectable vitamins B1 and AEvit. In the case of severe pubertal gynecomastia, treatment with bromocriptine and its analogues and the use of prolactin inhibitors are accepted. In the hypopubertal variant, the level of testosterone in the blood is increased with the help of steroid drugs.

In the treatment of the elderly, it is important to choose expectant tactics, which include an active differential diagnostic search for the cause of gynecomastia.

Operation types

There are three types surgical treatment for gynecomastia:

1. traditional mastectomy - removal of the nipple-areolar complex.
2. subcutaneous - preservation of the nipple and halo
3. endoscopic - removal of seals, used for small glands

When lowering the nipples in men, an incision is made from above, removing the tumor and pulling the skin back to its natural state. Mastectomy is performed under general or local anesthesia. AT rehabilitation period Be sure to wear a bandage to avoid chest deformity.

Rehabilitation

In the two-week period of suture healing, men experience pain and discomfort. To remove them, painkillers and restorative drugs are prescribed.

In the first three days, bed rest is strictly observed without lifting weights, other physical exertion, so as not to damage the integrity of the seams.

1. wear a bandage for three weeks, do not remove at night
2. follow a gastrointestinal-friendly diet to avoid constipation and other digestive disorders
3. with the appearance of complications: temperature, suppuration of the sutures, severe pain, general weakness, seek urgent medical attention

Prognosis for the treatment of gynecomastia in men

Infantile gynecomastia has the most favorable outcome and it doesn't need to be treated. Since the appearance of the disease is not caused by pathology in the body of the baby, but by a temporary phenomenon. In adolescent boys, symptoms resolve with treatment during puberty: 75% within the next two years, the remaining 15% after three years.

The treatment of gynecomastia caused by destructive processes in men is as favorable as it is possible to eliminate the cause that caused the change in the glands. At dosage form treatment is favorable, as the doctor simply changes the drug to a safer one. With gynecomastia caused by organ pathologies, the prognosis depends on the treatment of the underlying cause.

Army and disease

The presence of this disease is not valid medical reason not to serve in the army. The only exceptions are those young men whose disease is caused by serious pathologies in the functioning of the endocrine, digestive or cardiac systems.

Youths passing by postoperative rehabilitation and having a positive dynamics of recovery, are fit for military service after full recovery.

Prevention of gynecomastia

Gynecomastia is dangerous because it can suddenly progress without the manifestation of vivid symptoms. The man feels neither discomfort nor external changes. But long course disease provokes the occurrence of breast cancer and an increase in axillary lymph nodes.

Proper prevention helps men avoid pathology and terrible complications:

• health care and examination by a doctor of the mammary glands
• a healthy lifestyle that includes avoiding bad habits organization of rational nutrition, the ability to competently relax and remove nervous tension, for example, drink teas from chamomile, thyme, yarrow, mint or lemon balm at night
• medications that may interfere with hormonal background should be supervised by a doctor
• treatment urological diseases and genital infections in men
• in case of any suspicious signs, the exclusion of self-treatment

Teenage boys and men with this pathology experience a lot of unpleasant sensations and experiences. In some cases, gynecomastia is completely harmless and goes away on its own, but there are situations when such a hormonal imbalance requires treatment and constant monitoring. This pathology can contribute to development in men and should not be left without adequate attention. In our article, we will tell you about the causes, types, symptoms, methods of diagnosis and treatment of gynecomastia. Such knowledge will help you avoid worries and complications.

Gynecomastia is the pathological growth of the mammary glands in men. It can develop into different periods life, from the first month of life and ending with old age. The growth of the mammary glands is provoked by a hormonal imbalance, which is accompanied by an increase in the level of female sex hormones or a decrease in the concentration of androgens.

Classification and causes of gynecomastia

Elevated estrogen levels can be caused by physiological and pathological causes, depending on this, gynecomastia is classified into physiological or pathological.

Physiological gynecomastia is characterized by age categories:

• gynecomastia of newborns: caused by the presence in the boy's body of estrogen from the mother's blood, which were introduced into his blood in the prenatal period, this pathology disappears on its own after 2 weeks (sometimes after a month), observed in 70% of boys in the first days of life;
• pubertal gynecomastia: caused by hormonal changes in the body and disappears on its own after 1-2 years (for 2 years this pathology is rare and is called persistent pubertal gynecomastia), observed in 35-55% of adolescents 12-14 years old;
• gynecomastia in older men: caused by age-related changes, which lead to a decrease in testosterone levels or an increase in estrogen levels, is observed in men 55-80 years old.

Unlike the physiological form of this pathology, pathological gynecomastia is a symptom of a serious disease that provokes a decrease or increase in estrogen levels. There are many reasons for its occurrence:

• testicular diseases: anorchia (congenital absence of two or one testicle), defects in testosterone synthesis, Klinefelter's syndrome;
• malignant and;
• oncological diseases: carcinoma or adenoma, tumors of the testicles, lungs, pancreas and stomach, chorionic carcinoma;
• hermaphroditism;
• infectious diseases: parotitis, herpetic lesions of the chest, orchitis, , pulmonary tuberculosis;
• violations of blood flow in the testicles;
• testicular injury;
• hypertrophy;
• pituitary tumors with hyperprolactinemia;
• cardiovascular failure.

Pathological gynecomastia can be caused long-term use some pharmacological preparations:

• diuretics such as Veroshpiron;
• hormonal agents for the treatment of prostate cancer;
• drugs for the treatment of coronary artery disease and hypertension: Verampil, Nifedipine, Amlodipine, Enap, Captopril, Diroton, Kapoten, Dopegit;
• cardiac glycosides, for example, Digoxin;
• antibacterial, antimicrobial and antimycotic agents: Isoniazid, Trichopolum, Ketoconazole;
• antiviral agents for the treatment of HIV-infected people;
• antiulcer drugs: Omez, Ranitidine;
• tranquilizers: Diazepam, Seduxen, Relanium;
• drugs: heroin, marijuana, alcohol.

Why is gynecomastia dangerous?

Physiological gynecomastia is not dangerous and regresses on its own. A boy or a man may be embarrassed by this appearance of the chest and experience some complexes, but understanding the cause of this condition or working with a psychologist can smooth out these unpleasant experiences.

Long-term pathological gynecomastia, in addition to the fact that it accompanies a progressive underlying disease, can cause the development of breast cancer. Given oncological disease quite rare in men, but accompanied by the same severe consequences as malignant breast tumors in women. The appearance of discharge from the nipple of a bloody nature, dense formations, ulcerations, changes in appearance skin over seals and an increase in nearby lymph nodes - such signs should alert a man and become a reason for an immediate appeal to a surgeon or oncologist.

Symptoms

Main characteristic symptoms Gynecomastia are an increase in the size of the mammary gland and breast growth. It should be noted that breast enlargement in a man due to the growth of adipose tissue does not indicate this pathology and is called pseudo-gynecomastia.

The increase in size and engorgement of the mammary glands in newborn boys is insignificant and does not cause serious inconvenience to the child. With other types of gynecomastia, the breast can grow up to 15 cm in diameter and weigh about 160 g. The mammary glands often enlarge on both sides. Sometimes one gland is enlarged more than the other. At unilateral gynecomastia, which is less common, the symptoms are the same, but this condition significantly increases the risk of developing breast cancer.

Patients with this pathology rarely complain of pain, but they note a feeling of pressure, discomfort and hypersensitivity nipples (especially when wearing clothes). In some cases, gynecomastia is accompanied by milky discharge from the nipples. Their areolas can be hyperpigmented and expand in size up to 3 cm.

Gynecomastia, which was caused by hyperprolactinemia, is accompanied by signs of damage to the central nervous system, oligospermia and impotence. Violations of potency in other types of this pathology are observed only in the case of a significant increase in estrogen levels and a significant decrease in the amount of testosterone. In some severe cases, libido may be completely absent.

An increase in estrogen levels in men can indicate the following signs: change in the timbre of the voice (it becomes higher), excessive irritability and tearfulness,. With pathological gynecomastia, changes in the shape, swelling and swelling of the testicles can be detected. All of the above signs should be the reason for an immediate medical examination.

During pathological gynecomastia, three stages can be distinguished:

• proliferating (first 4 months): accompanied by initial symptoms, which can regress with adequate therapy;
• intermediate (about 4-12 months): accompanied by maturation and growth of breast tissue;
• fibrous: accompanied by the appearance of connective and adipose tissue in the mammary gland, chest with dense seals, regression pathological process practically impossible at this stage.

Diagnostics

Determining the level of sex hormones in the blood will help identify hormonal imbalances in the body.

A presumptive diagnosis is established by an endocrinologist based on complaints, questioning and palpation of the patient's chest and axillary lymph nodes. To confirm gynecomastia, ultrasound of the mammary glands and lymph nodes is performed.

To detect violations in the hormonal balance, blood tests are prescribed to determine the concentration of:

• testosterone;
• estradiol;
• prolactin;

With an increase in the levels of chorionic hormone or etsradiol, the patient is immediately prescribed studies to exclude cancerous tumor. Mammography, biopsy and subsequent histological analysis of breast tissue may be needed. In some cases, to exclude the oncological process, the following may be prescribed:

• Ultrasound of the scrotum;
• computed tomography of the adrenal glands.

If necessary, you may need additional consultations doctors of other specialties: therapist, neurologist, urologist or oncologist.

Treatment

Physiological gynecomastia of newborns goes away on its own. With the pubertal form of this pathology, drug treatment, as a rule, is not prescribed. A teenager is observed by a doctor, and in the absence of positive dynamics for six months and a significant increase in estrogen levels, he may be prescribed hormonal correction. For this, drugs such as Danazol, Clomiphene, Testolactone, Dihydrotestosterone, Tamoxifen are used. Psychological work is also carried out with a teenager, which is aimed at eliminating complexes and neuroses.

Treatment of pathological gynecomastia can only be prescribed by a doctor after establishing the cause of its occurrence. Initially, the patient is prescribed conservative therapy aimed at treating the underlying disease that caused the hormonal imbalance.

With a low level of testosterone, patients take drugs based on this hormone. Such therapy is effective during the first 4 months. Testosterone supplementation has no effect in older men and patients with normal level androgens, and they are assigned to correct other hormones. With an increased level of estradiol, the patient is recommended to take antiestrogens (Clomiphene, Nolvadex, Tamoxifen, etc.).

Gynecomastia caused by taking medicines, treated by replacing pharmacological agent or reducing its dosage.

In the absence of positive dynamics from conservative therapy, long-term gynecomastia with fibrotic changes or the detection of a malignant process in the tissues of the mammary gland, the patient is prescribed surgical treatment.

Depending on the prevalence and type of pathological process, the following operations can be performed:

• endoscopic mastectomy: can be performed with minimal breast enlargement, this is a minimally invasive operation, performed using an endoscope;
• areola-sparing mastectomy: performed by paraareolar access;
• mastectomy with liposuction: performed by paraareolar access, excess adipose tissue is additionally removed.

Endoscopy and subcutaneous mastectomy well taken by the sick. The patient quickly recovers after the operation and after 2 days he can be discharged from the hospital.

AT postoperative period he must follow a number of recommendations: to limit physical exercise and for 2-3 weeks wear special underwear to correct the muscle contour and correct skin contraction.

After a week, the patient can start light work, and after a month, more intense physical activity or sports training is allowed.

Forecasts

Physiological gynecomastia in most cases is characterized by favorable prognosis and disappears on its own. In 75% of adolescents, the hormonal background is restored within two years.

Often (especially with physical contact with tight clothing, etc.) there is a painful hardening of the mammary glands, which then spontaneously disappears. The size of the breast enlargement can be different - from 1 to 10 cm. The average size is about 4 cm.

Very often, gynecomastia occurs in male athletes due to a sharp removal of stress, as well as with constant psychological stress. Potential balance of female and male hormones with active sports life violated in favor of testosterone. In the absence of loads and under the influence of constant negative psychological factors, the balance is shifted towards female hormones.

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Etiology

The cause of gynecomastia can be various endocrinopathies: Klinefelter's syndrome, testicular feminization, Reifenstein's syndrome, castration and hypothyroidism, testicular tumors (appearance of Leydig cells), choriocarcinoma, tumors of the pituitary and adrenal glands. Gynecomastia may be a tumor syndrome in bronchial cancer. It also occurs with cirrhosis of the liver, dystrophy from starvation, leprosy. It should also be noted the occurrence of gynecomastia in men who were actively involved in sports in the past, followed by a sharp cessation of exercise. AT recent cases Gynecomastia can occur from a year to decades without causing complications. Breast growth in such cases does not pose a clinical danger.

A number of drugs for long-term use can lead to gynecomastia: spironolactone, digitalis, methyldopa, reserpine, meprobamate, phenothiazine, risperidone, ketoconazole, cannabiants, hormone therapy with estrogen, testosterone, or gonadotropin.

Classification

1. True gynecomastia. Breast augmentation occurs due to glandular tissue. A dense formation is palpated under the nipple, and on ultrasound the doctor ultrasound diagnostics finds a gland.
2. False gynecomastia or lipomastia. The breast increases due to adipose tissue. Basically, lipomastia is observed in obese men.
3. Mixed gynecomastia. Combination of true and false gynecomastia:
   • with a predominance of adipose tissue.
   • with a predominance of glandular tissue.

Patients often have an increase in both mammary glands at the same time. Then they talk about bilateral gynecomastia. But sometimes it happens that only one mammary gland increases - unilateral gynecomastia.

Clinical picture

There is a feeling of heaviness, fullness, itching and discomfort in the region of the mammary glands. On palpation, a densely elastic mobile formation with clear contours is determined, painless. Regional lymph nodes are not enlarged.

Diagnostics

1. To establish the diagnosis of gynecomastia, it is necessary to perform an ultrasound of the mammary glands.
2. For diagnosis, it is also important to find the cause of gynecomastia.

To do this, examine the hormonal profile (testosterone, estradiol, prolactin, LH and TSH). Often patients with gynecomastia have elevated level estradiol and reduced level testosterone. Gynecomastia can develop while taking anabolic steroids to increase muscle mass therefore it is very important to know the patient's history. Gynecomastia may accompany such genetic diseases like Cullman's syndrome, Klinefelter's syndrome. It is necessary to diagnose these diseases. With hypogonadism, the development of gynecomastia is also possible, therefore it is also important to examine the testicles, the prostate gland and the hormonal spectrum (testosterone, estradiol, LH, FSH, TSH).

Differential Diagnosis

Differential diagnosis of gynecomastia is not difficult. Gynecomastia is a benign enlargement of the breasts. Therefore, the main differential diagnosis to rule out breast cancer. But breast cancer is rare in men. For this, a puncture of the formation is performed, followed by a study. cellular composition. It is also possible, after the removal of the mammary glands, to produce them histological examination for the purpose of convincing that it was gynecomastia and not cancer.

Treatment

Treatment of gynecomastia is surgical and therapeutic. Shown only in malignant tumors. Hormone therapy does not always give the desired result. In some cases, testosterone treatment has the opposite effect. Also in the treatment of gynecomastia hormonal drugs dramatically increases the risk of cancer. It is strictly contraindicated to “squeeze” the mammary glands with tight bandages in order to slow down growth. Such actions lead to a violation of blood exchange, the occurrence of congestion and, as a result, the occurrence malignant tumors.

Anesthesia

The operation can be performed under local or general anesthesia.

• For local anesthesia use a 0.5-1% solution of lidocaine, which is injected into the mammary gland and into the surrounding subcutaneous fat. This option of anesthesia is suitable for patients who want to have surgery without hospitalization.
• Brief sedation combined with local anesthesia. During the operation, the patient is asleep, but additionally he is subjected to local anesthesia with 0.5-1% lidocaine solution. After the operation, it takes about 2-3 hours to spend in the ward, and then the patient can be discharged. On this day, you should refrain from driving a car and drinking alcohol.
• General anesthesia necessary for patients who plan to remove large volumes of gynecomastia, as well as for lipomastia for liposuction with a tightening of the nipple-areolar complex. This type of anesthesia requires hospitalization for 1-2 days.

Types of operations for gynecomastia

The choice of the operation method depends on the volume of the mammary glands, the amount of subcutaneous fat and the need to tighten the skin. With true or mixed gynecomastia small sizes subcutaneous mastectomy is indicated with the formation of a "platform" under the nipples in order to prevent retraction of the nipples. With lipomastia, 2 options for surgery are possible: liposuction or lipectomy (subcutaneous removal of adipose tissue). It is possible to use special postoperative compression underwear. The formation of hematomas and bruises is not excluded, since small vessels are damaged during the operation. These bruises usually go away within 2-3 weeks.

An increase in the mammary glands in men is formed as a result of the fact that adipose or glandular tissue grows. The disease can be either unilateral or bilateral. Breast compaction often develops during puberty, after which it goes away on its own. Often, a violation occurs in athletes, for example, practicing bodybuilding, due to the lack of exercise and the use of anabolic steroids. So that the hormonal balance does not shift towards female hormones, you need to carefully select the training program on the course.

The mammary gland can increase from 1 to 10 cm. Symptoms of the disease are expressed in breast compaction, painful sensations with palpation and a feeling of heaviness. In the absence of a result from conservative treatment, surgical intervention is indicated, since neglected gynecomastia can develop into breast cancer. ICD-10 disease has the number N62. The army and gynecomastia are quite compatible, so they don’t give a delay with such a diagnosis.

Disease classification

Exist false and true form of the disease. In some cases, they can be combined, for example, with dispituitarism in adolescents. The first form includes pseudogynecomastia, that is, this is breast enlargement with body fat in boys or men, when there are no alveolar formations in the tissues.

true gynecomastia it happens physiological and pathological. The first form includes newborn, adolescent and senile gynecomastia. The pathological appearance develops with genetic and iatrogenic pathology, hormonal and somatic diseases, genetic disorders and paraneoplastic dysfunction (testicular cancer, breast cancer, kidney cancer, etc.).

stands out diffuse(extensive) and nodal(partial) prevalence of the disease.

One-sided Male gynecomastia usually develops with increased local sensitivity of the breast to blood estrogens. The mammary gland on the left is more often affected. double sided the form of the disease means that both breasts are affected at the same time, although the intensity of the disorders usually varies.

There are 3 stages of development:

1. Developing- the first period, lasting about 4 months. Changes are reversible and conservative therapy is sufficient.
2. Intermediate the form can last up to 1 year. Breast tissue changes.
3. Fibrous- fat cells are deposited in the mammary gland, and mature connective tissue is formed, reverse development is impossible.

Clinically, there are 4 degrees of gynecomastia:

I degree- the least subareolar nodularity;
II degree- seal smaller size areola;
III degree - the node has the volume of the areola;
IV degree- the seal is larger than the pigmented area around the nipples.

By size conditionally distinguished moderate(up to 6 cm), the average(up to 10 cm) and expressed(more than 10 cm) education. Calculate it according to the formula, taking into account the height and circumference of the gland.

Symptoms and signs

Due to fetoplacental blood and a large amount of maternal estrogen in children, including girls, transient gynecomastia may develop after birth. This phenomenon is characteristic of a large part of newborns; over time, the pathology goes away on its own.

The pubertal transient form of the disease as a natural phenomenon is observed in 35-85% of boys in the process of puberty. At this age, guys usually have a minimal, slightly noticeable increase in the mammary glands. Usually there is a bilateral increase, in the case of a unilateral formation, the asymmetry can be quite strong.

The causes of this form of gynecomastia are not fully understood. It has been established that during puberty, the production of estrogen is higher than testosterone, which contributes to hormonal imbalance. There is an opinion that the ratio of gonadotropins and PRL is to blame. Since FSH secretion is released with an increase, the number of testicular cells increases, and LH secretion reaches the “male” level only after 2 years. In this case, there is a slight proliferation of the milk ducts. Of course, this causes mental discomfort and anxiety in young man: instead of the desired maturity, feminization occurs. The young man tries to hide gynecomastia, avoids playing sports, is embarrassed to undress in front of his peers. As a rule, after 6-18 months, all symptoms spontaneously disappear.

The juvenile form of the disease may be hereditary, but fathers often forget that they had such disorders in their past, which complicates the history taking. Usually no treatment is needed during puberty, just a little wait.

At this age, only with persistent gynecomastia, breast enlargement is preserved. Moreover, this form is practically not amenable to conservative therapy and often requires surgery. According to statistics, approximately 1/3 of the adult representatives of the stronger sex have gynecomastia, which is manifested by the proliferation of the ducts of the mammary gland and stroma. This is due to the influence of environmental, pathopharmacological and other factors.

Brief interesting data
- Lenehin first described gynecomastia in 1771.
The disease got its name from two Latin words gyne - woman and mastos - chest.
- During puberty, gynecomastia occurs in 50-70% of adolescents and up to 70% of older men.

Often, doctors do not pay due attention to the problem of the disease, which leads to late treatment and the formation of large nodes. This causes severe discomfort to young men and can even lead to suicide attempts. The operation does not help to eliminate the defect and does not contribute to masking the anomaly. Insofar as postoperative scars often in the future provoke an increased interest in women. Against this background, depression may develop. Often, the clinic of gynecomastia is supplemented by disorders of sexual development - testosterone is produced inappropriately for age, delay or, conversely, premature development of the penis and testicles, obesity, the formation of a eunuchoid phenotype, or feminization.

Severe complications are expressed in the development of the female type, unnatural distribution of subcutaneous adipose tissue and supination of the forearms. This is due to the loss central department regulation of the reproductive system.

Complications

If left untreated for more than a year, gynecomastia can undergo fibrosis (scarring), making therapy difficult medicines. Also, the disease can leave serious psychological consequences and contribute to the emergence of an inferiority complex.

Most dangerous complication- the degeneration of gynecomastia into cancer. According to statistics, 20-60% of cases of malignant breast tumors in men are formed against the background of the disease.

After surgery, there may be signs such as skin tears, breast asymmetry, infectious complications, scarring or scars. Serious violations requiring reoperation, are extremely rare.

In overweight men of mature age, after the removal of a large amount of tissue, circulatory insufficiency may develop, which leads to necrosis of the nipple. His sensitivity, when changing his usual position, sometimes decreases or disappears completely.

Causes of the disease

Estrogens, androgens, prolactin, growth hormone, gonadotropic hormones of the pituitary gland affect the formation and functioning of the mammary glands. They consist of two sections: secretory and interstitial.

Allocate interstitial transformation with the deposition of fat cells, growth connective tissue and parenchymal with proliferation of milk ducts. The first type is associated with the influence of testosterone, estrogen and progesterone. The second form is prolactin, since there is an excessive production of prolactin.

Studies have shown that the same hormones affect the condition of the mammary glands in women as in men. Gynecomastia is accompanied by an increased accumulation of estradiol in the body. A long-term disease leads to fibrosis and hyalinization of the gland tissue.

Gynecomastia is a pronounced symptomatic manifestation absolute or relative hyperestrogenemia. Estrogens are produced in the body of any healthy man, but an increase in their secretion or exogenous administration is a pathology. The role of the hormone prolactin in the development of gynecomastia is not completely clear, but nevertheless, we must not forget that it increases the sensitivity of target organs (kidneys, liver, etc.).

During pregnancy, how the conception of the mammary glands will take place in the fetus is determined by the set of sex chromosomes, and it is he who may be the result of sensitivity to hormonal influences.

From all of the above, we can conclude that the causes of gynecomastia may be an increase in the production of estrogens and PRL, a violation of the metabolism of estrogens, androgens in the liver, increased tissue sensitivity to them, functional hyperprolactinemia, regular contact with drugs containing estrogens or blocking androgens.

Some diseases of organs and systems can contribute to the development of gynecomastia: liver cirrhosis, hyperthyroidism, trauma chest or her defeat herpetic infection, adrenal tumors, diabetes mellitus, pulmonary tuberculosis, renal and liver failure, HIV infection.

Diagnostics

Compaction and nodes of the mammary gland can be detected by palpation, which can be very painful. At the same time, their consistency, symmetry, and size are evaluated. Also, with the help of palpation, an increase in lymph nodes, the condition of the nipples, their displacement and mobility, adhesion with other tissues are diagnosed. Gynecomastia is often accompanied by secretion from the nipple, which is usually serous colostrum, rarely develops profuse galactorrhea.

First of all, the doctor tries to determine false gynecomastia or true, pathological or physiological. He will definitely clarify how long ago the breast began to increase and whether the progression of the process occurs. The development of symptoms of erectile function, hypogonadism, fertility and sexual desire is detected. Diagnosis includes determining the location of subcutaneous fat, the nature of hair growth and the timbre of the voice, examining the genitals.

It is necessary to take tests for the level of hormones in the blood: PRL, LH, testosterone, FSH, TSH, estradiol, hCG. It is also necessary to examine creatinine, liver enzymes and evaluate the results of an x-ray of the chest and chest (mammography), in some cases an ultrasound of the testicles is indicated. Patients with incomplete puberty do CT or MRI of the adrenal glands.

Treatment

Treatment of gynecomastia should be carried out by an endocrinologist or mammologist.

First of all, it is necessary to establish and eliminate the cause of the disease. For example, if gynecomastia is a consequence of taking the drug, it is enough to cancel it or replace it with another one.

Usually, up to 6 months, the disease is simply observed and waiting for an independent regression. If it does not occur, then they try to get rid of the increase in the mammary glands with the help of hormonal treatment: clomiphene, testosterone, tamoxifen and danazol. Gynecomastia in adolescents is usually treated with bromocriptine. Aevit and vitamin B1 are also shown.

Surgical removal (mastectomy) is performed only with a pronounced cosmetic defect, if there is a suspicion of cancer development or if there is no result from conservative treatment. Mammoplasty helps to remove breast tissue with the formation of a bed under the nipple to prevent its retraction.

Prevention

Prevention of the disease consists in the careful selection of medicines, the rejection of anabolic steroids, healthy lifestyle life without drugs, alcohol and overeating and the exclusion of causes that can provoke gynecomastia. Treatment should begin as soon as possible, because the longer the course, the higher the likelihood of degeneration into cancer.. In the diet of a man, wholesome and plant foods should prevail.

Folk methods of treatment

At home, the patient must follow all the recommendations of the doctor. Unfortunately, folk remedies in the treatment of gynecomastia are powerless. In order to normalize the psychological background, you can brew sedative herbs or use them in tincture (motherwort, peony, valerian).

In men, there are several variants of gynecomastia. They differ in the composition of the tissues that form the enlarged breast.

It could be:

• breast tissue (true gynecomastia);
• adipose tissue ();
• both at the same time (mixed gynecomastia).

True gynecomastia requires special attention, since this type of disease indicates a significant imbalance of sex hormones.

In about half of patients, the problem is caused by a decrease in tissue susceptibility to androgens..

The tendency to breast growth is often inherited.

It also happens that gynecomastia develops at the stage of puberty and the volume of the mammary glands remains at the same level throughout life, while tests do not show any hormonal abnormalities in the body.

Note! Gynecomastia can develop in both breasts or only one.

Gynecomastia caused by obesity does not need therapy. carried out only at the request of the patient.

Symptoms of the disease

With true gynecomastia, a man is concerned not only with the appearance of the mammary glands, but also with discomfort. The patient may experience heaviness, itching, soreness. The contact of nipples with clothing can be unpleasant.

The glands themselves are dense to the touch, have clear contours. The nipples may also be unusually large and become more pigmented. The tissue of the gland is firmly connected to the muscles of the chest and skin.

There are three stages in the course of the disease.:

1. The stage of growth of the mammary glands, it lasts about four months. If you start on time drug treatment, the breast can completely "resolve".
2. An intermediate stage, its duration is from four months to a year. Breast tissues gradually mature, and conservative treatment becomes less and less effective.
3. Fibrous stage, when changes in the breast become irreversible. With the help of medicines, you can slow down the course of the disease, but it will not be possible to make the already grown glands disappear.

Important! If during the first year of the disease you do not start conservative treatment true gynecomastia, in the future it will be possible to get rid of large breasts only by surgery.

Age groups

Breast growth can occur at any age. The mammary glands are very sensitive to the slightest fluctuations in the ratio of androgens and estrogens.

The smallest decrease in androgen activity can trigger breast growth.

Children and teenagers

Gynecomastia in newborns is a common and not dangerous to health phenomenon.

Approximately half of the boys during the first month of life can notice swollen mammary glands.

This is due to the fact that a small amount of maternal sex hormones that have penetrated through the placenta remains in the blood of a newborn child.

Also, part of the hormones enters the blood of the baby through breast milk.

For the treatment of true gynecomastia in men, conservative and surgical methods . suggests A complex approach. Firstly, you need to recover from the underlying disease that caused the development of gynecomastia, and secondly, to establish a hormonal balance in the body.

If the problem arose while taking medications, drugs are used that reduce estrogen levels.

To surgical intervention come running when drug therapy has not produced the desired effect for two years, and the patient wants to reduce his mammary glands for aesthetic reasons.

In addition, surgery is indispensable if gynecomastia has arisen due to a tumor formation.

Attention! Some patients try to stop the growth of the mammary glands by squeezing them with tight bandages. You can’t do this: firstly, this method does not give any effect, and secondly, it causes a violation of blood flow, which increases the risk of malignant tumors.

Conservative method of treatment

In the course, conservative therapy is first involved.

Surgery to remove the mammary glands is done in case of malignancy in the gland or at the request of a patient who is dissatisfied with his appearance.

Conservative treatment started on early stage diseases, is most effective and helps to reduce the mammary glands without surgery.

At the intermediate stage, the prognosis is less favorable: you can stop breast growth, but it will no longer “resolve” on its own.

In the third stage, when the breast is fully formed, it can be eliminated only during surgical intervention.

The following drugs may be involved in the treatment:

• antiestrogens (, clomiphene, danazol);
• testosterone and human chorionic gonadotropin;
• aromatase inhibitors (testoplankton, thiamine bromide).

The doctor may also prescribe a course of injections of vitamins B1, A and E. To enhance the effect of hormone therapy, you can add drugs that improve blood circulation in the brain (cavinton, cinnarizine, actovegin).

Hormonal treatment does not always give a good result, especially with testosterone therapy.. In addition, the use of hormonal drugs is accompanied by side effects and increases the risk of developing cancer.

Surgical method of treatment

Surgical reduction of the mammary glands is performed if drug method gave no result.

What operation can the surgeon suggest??

1. Subcutaneous mastectomy. An incision is made in the areola area, through which the gland tissue is removed, then the skin is sutured in such a way as to give the breast an aesthetic outline.
2. Endoscopic mastectomy. During this operation, a puncture is made in the armpit, tissues are removed using endoscopic equipment.

Anesthesia can be local or general. In the case of local anesthesia, the patient can go home two to three hours after the operation, after general anesthesia I have to stay in the hospital for a couple of days.

Full recovery will take three to six weeks..

After surgery, you will have to wear tight-fitting underwear for several weeks, which helps to form an aesthetic surface of the breast. Muscles and The lymph nodes during the operation are not affected, so it is less traumatic.

Useful video

For more information about gynecomastia in men, see the video below:

So, a man who has discovered signs of gynecomastia should not hide under baggy clothes, but take care of his health.

True gynecomastia in men is much more of a nuisance than an aesthetic defect that can be quickly eliminated with surgery.