Anatomy
Causes of Gynecomastia
Diagnosis of Gynecomastia
History of gynecomastia treatment
Treatment of gynecomastia

Gallery


Gynecomastia and the Famous

  • Arnold Schwartzenneger
  • Bobby Flay
  • Harrison Ford
  • Ice T
  • Jack Nicholson
  • John Travolta
  • Phil Mickelson
  • Roberto Cavelli
  • Simon Cowell
  • Ted Kennedy
 

Imaging the Male Breast

  • Normal Male Breast
    This xray shows a small amount of connective tissue behind the nipple-areolar complex.
  • Normal Male Breast2
    Vessels are more prominent in this study and there is more fat seen.
  • Lipomastia
    In lipomastia there is no increase in fibro-glandular tissue, but simply in fat. The breast is feminized, but without the addition of glandular tissue. This form is particularly common in obesity, liver disease and old age.
  • Diffuse Glandular
    This pattern is common in any conditions associated with high estrogen levels.
  • Nodular Pattern
    This is common early, during the "florid" phase. There are increased number of ducts, edema (swelling), and increase in a cellular, fibroblastic "stroma."
  • Nodular Pattern Lines
    This image shows the sharply delineated edges of a nodular gynecomastia behind the nipple-areolar complex.
  • Dendritic Pattern
    Here is seen a "dendritic" pattern where the density beneath the areolae shows prominent extensions into the surrounding fat.
  • Leimyoma
    This lesion appears very much like fibroadenoma in females, but men do not get fibroadenoma. Leimyoma is a well-circumscribed, rubbery mass.
  • Myofibroblastoma2
    Myofibroblastoma is actually more common in men than in women. It is a well-circumscribed and non-calcified mass that is freely movable and firm. It occurs at a mean age of 50 years.
  • Granular cell tumor
    Granular cell tumor is a benign growth of neural origin, and 6% of them occur in the breast. These are most common in men during their 30's, and may mimic unilateral gynecomastia. However, when the mass is not centered behind the nipple, it should be biopsied.
  • Granular Cell Sonogram
    Granular Cell tumor as seen on ultrasound, (sonogram).
  • Granulomatous Mastitis
    Granulomatous disease of the male breast can be seen with conditions such as tuberculosis and sarcoidosis.
  • Carcinoma
    This mass is eccentric with respect to the nipple and has a tell-tale irregular, "spiculated" appearance.
  • Carcinoma Sonogram
    This ductal cancer shows pseudoencapsulation on ultrasound.
  • Carcinoma vs. Gynecomastia
    Distinguishing carcinoma from gynecomastia can sometimes be difficult by xray alone. Here the cancer on the right is a bit more encapsulated than the gynecomastia at the left. Biopsy is necessary here to differentiate.
  • Carcinoma vs. Gynecomastia
    This also shows how difficult it may be to discern the difference between a concentrated glandular gynecomastia and an invasive ductal cancer.
  • Liposarcoma
    This is an unusal tumor that usually presents as a slowly enlarging, painful mass on one side. On xray it looks like water density, (white), rather than like fat, which shows up dark.
 

Gynecomastia Surgical Incisions

  • Liposuction
    Liposuction alone can recontour the chest for many with lipomastia and fat-predominant, mature gynecomastia. Many surgeons prefer the use of power-assisted or ultrasound-assisted methods to maximize fat removal.
  • Webster
    Dufourmentel described the intra-areolar incision in 1928. Although he illustrated its use in gynecomastia surgery, it was not until J.P Webster described his 1934 use of the incision in his 1946 tome that the approach became codifed.
  • Simon Omega
    In 1964, Simon added transverse extensions to Webster's design in order to create better access for larger glands with small areolae. A similar design had been suggested for skin excision in 1946 by Malbec.
  • Pitanguy
    In 1966, Pitanguy championed the use of a transverse access across the areola's greatest transverse diameter and across the nipple.
  • Letterman 1969
    Letterman and Schurter's 1969 design moved the incision to the supra-areolar area and removed a lunate-shaped piece of skin to allow areolar movement superiorly to prevent drooping or folding of the areola.
  • Letterman 1972
    In 1972, Letterman and Schurter brought Dufourmentel and Mouly's "oblique technique" of mammaplasty to the treatment of large gynecomastias. The technique allowed significant skin and gland resections while providing for upward transposition of the nipple-areola.
  • Transverse
    Very large gynecomastias require large skin resections. One approach is use of a skin-gland resection much like mastectomy in women for cancer.
  • IMF
    Depicted here is another option for those needing large skin excision. It is of particular use in the massive weight-loss population. Here, skin is removed from the infra-mammary fold upward and the nipple, (based upon a superior or inferior pedicle), is brought out through a skin cutout. If the blood supply to the nipple is in question, the transfer of the nipple-areolar complex is changed to a free, composite graft.
 

Surgical Transitions

  • 1
    A young patient with diffuse, largely fatty gynecomastia and good skin quality.
  • 1
    Power-assist liposuction (PAL) was used to obtain the change seen here.
  • 1
    In a relatively short time, the skin has shrunk to accomodate the reduced contour.
  • 1
    This young man's gynecomastia is limited to a small area immediately beneath the areola. This produces a conical projection that many find objectionable.
  • 1
    The dense, discreet firo-glandular mass is directly excised, and would not be usefully treated with liposuction.
  • 1
    A peri-areolar incision was used for access and has healed in a way the patient finds acceptable.
  • 1
    Adolescent gynecomastia is often bilateral, but usually asymmetric. In some instances, as shown here, it is entirely unilateral.
  • 1
    A direct glandular excision via a Webster incision has produced a result acceptable to the patient.
  • 1
    This form of gynecomastia involves more than the area beneath the areola, but is not complicated by extra skin.
  • 1
    Men in their twenties with persistent adolescent gynecomastia may have mixed, fibrofatty composition.
  • 1
    This treatment was accomplished with a combination of direct excision of gland, and peripheral liposuction.
  • 1
    When gynecomastia of adolescence persists beyond two years, it is very unlikely to regress.
  • 1
    This patient in his late teens has tissue growth over a 6 cm in diameter. The skin quality of the young patient is quite good.
  • 1
    These dense gynecomastias require direct excision. The youthful skin redrapes itself nicely in most cases.
  • 1
    Anabolic steroids used by body builders present the body with an over-abundance of androgen, which can be 'aromatized' into estrogen.
  • 1
    Bodybuilders often get "puffy nipples" from discreet masses beneath the areola. They are treated by direct excision via a peri-areolar or trans-areolar approach.
  • 1
    Obesity may cause true gynecomastia because of the peripheral fatty conversion ('aromatization') of androgens.
  • 1
    In many cases, the obese will be found to have 'lipomastia,' or 'pseudogynecomastia.' Such cases can be treated with suction lipectomy alone.
  • 1
    In this instance, there was obesity and true gynecomastia. The patient was treated with excision and peripheral suctioning of breast and chest.
  • 1
    Lipomastias are quite common in those of middle and later years.
  • 1
    Fatty excision is easily accomplished with suction alone, but the skin has more limited ability to contract than in the young.
  • 1
    Many find that the minor skin looseness that can persist after this treatment is to be preferred to the scars produced when skin is excised for tightening.
  • 1
    Among the many medications causing gynecomastia are narcotics. This elderly man was on powerful narcotics for years to deal with chronic back pain.
  • 1
    Excision of such a large gynecomastia promises to leave redundant skin in an elderly patient. Here a Letterman-Shurter type excision and nipple transposition was performed.
  • 1
    Such a pendulous, tubular breast as seen here cannot be expected to take good shape without skin excision. In this case, a transverse skin excision with nipple-arolar grafting was accomplished.