Gynecomastia N62.x

Author: Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 29.10.2020

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Breast augmentation of the man,

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Enlargement of the male mammary gland on one or both sides by increasing the glandular tissue or by increasing the fat deposit in the breast region.

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Causes of pathological gynecomastia (varies according to scale HC et al. 2018)

Idiopathic gynecomastia

  • Familial gynecomastia of unknown genesis

Disturbance of the androgen-estrogen balance:

  • Persistent Puberty Gynecomastia
  • Therapeutic estrogen supply
  • Hyperprolactinaemia (see prolactin below)
  • Klinefelter's syndrome,
  • Leydig cell tumor
  • Sertoli cell tumor
  • Adrenal Cattle Tumours
  • Hyperthyroidism
  • Hypogonadism (hypo-, hypergonadotropic)
  • Ectopes h CG production by malignant tumors (paraneoplastic syndrome) bronchial carcinoma, hepatocellular carcinoma, renal cell carcinoma.

General diseases

Drug therapies:




Phytotherapeutics with oestrogen-like active ingredients



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Physiological: neonatal age (up to 90% of male newborns develop a harmless and rapidly reversible gynecomastia), puberty (40-70% of adolescents are affected) The prevalence in the adult population is reported to be 30-60%. It is highest in the senium.

Clinical features
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One-sided or double-sided enlargement of the nipple and areola. In strands the glandular tissue is enlarged and painfully palpated. Galactorrhea is very rarely observed.

To objectify a gynaecomastia, various measures are suggested:

  • Thickness of a horizontal skin fold to be palpated, including the nipple (>2cm, in obesity >3cm)
  • Diameter of the areola (>3cm)

The classification is generally based on the stadium classification according to Tanner:

  • B1: No glands palpable
  • B2: areola enlarged, gland bulging
  • B3: Glands> areola
  • B4: Solid gland
  • B5: Corresponds to the female breast

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Hyperplasia of the gangetic epithelia and myoepithelial cells.

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Exclusion of a malignancy by sonography, mammography, if necessary bioptic securing or fine needle aspiration.

Differential diagnosis
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  • Gynecomastic fat breast in general obesity (pseudogynecomastia or lipomastia).
  • In case of unilateral or asymmetrical gynaecomastia: breast carcinoma (rough nodular infiltrates, retraction and mammary secretion)
  • Fibrosis
  • Fibroadenomas.

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  • The treatment depends on the exclusion of possible causes according to individual aspects (psychological strain on the patient through female appearance). As there is a high tendency to spontaneous regression, a wait-and-see attitude is justified.
  • Identification of the trigger and exclusion of the same.
  • If the cause is mainly medication, discontinuation of the medication causing the problem.
  • Drug therapy: Smaller clinical studies and case series have investigated different concepts of drug therapy. However, the data situation is poor. The best evidence is for the use of anti-estrogenic therapies, e.g. with tamoxifen, danazol and the aromatase inhibitors testolactone and anastronazole.
  • Surgical removal of the glandular tissue in the case of prolonged (6-12 months) fibrosing gynecomastia.

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Gynecomastia is not pathological in every case. In infancy and puberty it is physiological and usually self-limiting. It is also not considered pathological in the senium.

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  1. Evans DL et al (2002) Breast enlargement in 13 men who were seropositive for human immunodeficiency virus. Clin Infect Dis 35: 1113-1119
  2. Ersoz H (2002) Causes of gynaecomastia in young adult males and factors associated with idiopathic gynaecomastia. Int J Androl 25: 312-316
  3. Ferrando J et al (2002) Unilateral gynecomastia induced by treatment with 1 mg of oral finasteride. Arch Dermatol 138: 543-544
  4. Paech V et al (2002) Gynaecomastia in HIV-infected men: association with effects of antiretroviral therapy. AIDS 16: 1193-1195
  5. Seibel V et al (1998) Incidence of gynecomastia in dermatology patients. dermatologist 49: 382-387
  6. Zimmerman RL et al (2000) Cytologic atypia in a 53-year-old man with finasteride-induced gynecomastia. Arch Catholic Lab Med 124: 625-627


Please ask your physician for a reliable diagnosis. This website is only meant as a reference.


Last updated on: 29.10.2020