Gynecomastia

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Classification according to ICD-10
N62 Gynecomastia
ICD-10 online (WHO version 2019)
Young man with adipomastia

Gynecomastia (from the Greek γυνή (gynē) = woman and μαστός (mastos) = breast ) is the one or two-sided enlargement of the mammary gland in men . The real gynecomastia by the proliferation of the glandular tissue is heated from a false gynecomastia through fat deposition - as in overweight and obesity ( obesity are distinguished (- occurs) lipomastia , Adipomastie).

This breast change is often perceived as embarrassing by the men concerned and can lead to sometimes considerable disorders of self-confidence.

Types of gynecomastia

Normal physiological change

  • Neonatal gynecomastia : caused by the mother's female hormones that were transmitted to the newborn through the placenta . It forms back again.
  • Puberty gynecomastia : develops in around 50% of boys during puberty and usually, but not always, resolves completely. For a long time it was believed that this pubertal breast growth is caused by the increased formation of estrogen and a resulting shift in the estrogen / testosterone ratio towards estrogen. A study in Denmark could not confirm this assumption. Instead, appeal to new findings that the significantly increased insulin-like growth factor insulin-like growth factor 1 (1 IGF) brings together with the increased estrogens that breast growth, also increased testosterone levels and an unchanged ratio of estrogen to testosterone.
  • Age gynecomastia : With increasing age, the proportion of adipose tissue mass increases compared to the decreasing body mass, which also increases the conversion of male hormones ( androgens ) into female hormones ( estrogens ) in adipose tissue. At the same time, male hormone production in the testes decreases.
  • Pseudogynecomastia (without increasing the mammary gland body also lipomastia resp. For general obesity ( obesity ) Adipomastie called). The transition from overweight to obesity is reached with a body mass index ( BMI ) of 30.

A particularly frequent occurrence was found among soldiers of the guard battalion at the Federal Ministry of Defense . One possible explanation is to be found in the repetitive carabiner attacks on the left chest when carrying out the formal protocol in the security service. The 211 operated patients showed a significantly different hormone status compared to a healthy control group.

Morbid (pathological) gynecomastia

A real gynecomastia is not an independent disease, but a symptom, because various hormonal disorders or diseases, castration or side effects of medication can lead to breast enlargement:

causes

Genuine gynecomastia is usually caused by hormonal disorders. The following can essentially be distinguished:

If the gynecomastia is unilateral, the presence of breast cancer in men cannot be ruled out. Most of the time, however, it is a fibroadenoma of the breast .

In Europe it has been described that excessive consumption of beer brewed with hops can contribute to the development of gynecomastia due to the phytoestrogen content of the hop blossoms . Nevertheless, the high intake of nutritional energy is essential when consuming alcoholic beverages (increase in body fat - so-called "false gynecomastia").

treatment

With real gynecomastia, from a health point of view, surgery is usually not necessary. Since the psychological stress caused by external influences is often very high in many of those affected, attempts are often made to bring about the regression of the breast by taking hormone preparations, but this does not lead to the desired success in all cases. If the breast is reduced in size by surgery, this is usually done by making a short incision on the edge of the areola , through which the glandular tissue and possibly excess body fat are removed.

However, surgery is only treating the symptom, not the cause, of gynecomastia. A sustainable treatment therefore requires depending on the cause of breast augmentation:

  • Change in diet (weight loss, less alcohol)
  • If possible, discontinue medication
  • If there is an existing androgen deficiency , male hormone can be substituted; side effects must be taken into account (see also testosterone intake ).

Prevention before using medication

Radiological irradiation of the breast tissue can partially or completely prevent the formation of gynecomastia through the use of antiandrogens. The success rate of this prophylaxis is between 60 and 92%.

Relief from ailments

With pronounced gynecomastia, symptoms such as mastodynia (feeling of pressure, pain in the chest), hypersensitivity of the nipples or skin irritation in the breast folds can occur. The movement of the tissue is also often perceived as uncomfortable. During exercise, this movement of the tissue can lead to severe pain. Compression shirts, a sports bra or brassiere can provide relief in these cases.

See also

literature

  • Nadine Slevogt: Puberty gynecomastia: androgen receptor determination in puberty gynecomastia and control tissue ( pathophysiology and histology), Hamburg 2005, DNB 976523833 (dissertation Universität Hamburg 2005, 64 pages).

Web links

Commons : Gynecomastia  - Collection of pictures, videos and audio files

Individual evidence

  1. Copenhagen Puberty Study → Mikkel G. Mieritz, Lars Lau Rakêt, Casper P. Hage u. a .: A longitudinal study of growth, sex steroids and insulin-like growtht factor I in boys with physiological gynecomastia. In: The Journal of Clinical Endocrinology & Metabolism , published online August 19, 2015, doi: 10.1210 / jc.2015-2836 ; endocrine.org (PDF).
  2. a b Hans-Peter Kuhne, Sandy Egler, Stefan Lenz a. a .: GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW 2012 / Gynecomastia in German soldiers: etiology and pathology . egms.de; Retrieved May 5, 2016. 2012.
  3. Arznei-Telegram , Berlin.
  4. B. Neu, V. Sautter, M.-L. Sautter-Bihl: Radiation therapy for the prophylaxis and therapy of anti-androgen-related gynecomastia in prostate cancer. Magdeburg 2010 ( degro.wcenter.de ( Memento of the original from February 21, 2014 in the Internet Archive ; PDF; 640 kB) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove it Note. ). @1@ 2Template: Webachiv / IABot / degro.wcenter.de
  5. lipomatoses . ( Memento of January 10, 2007 in the Internet Archive ) In: Medical dictionary. m-press munich