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

Gynecomastia in History

The famed Roman physician and philosopher, Galen, (also known as Claudius Galenus and Galen of Pergamum) introduced the term "gynecomastia" in the second century A.D. He described gynecomastia as an abnormal increase in the fat within the male breast, and interestingly, considered male breast gland enlargement as a different condition altogether. There is no indication from historical sources of any efforts to treat the gynecomastic conditions that Galen described, however.

It was probably not until five centuries later that the first attempt at surgical correction of gynecomastia was made. In his surgical works, Byzantine physician Paulus of Aegina described a treatment for what he called an "effeminacy of men," detailing a male breast reduction operation. His collection of Greek medical knowledge, known as the "Medical Compendium in Seven Books," remained a "prescribed textbook" in Paris many centuries later, and served as great inspiration to Arab and Persian physicians who carried their medical and surgical traditions throughout southern Europe.

Paulus described a number of characteristics of the problem that we still appreciate as important today. Among these were:

  • the transient nature of gynecomastia among most adolescents
  • the importance of fat deposition to some, but not all cases

Paulus of AeginaHe described a surgical procedure employing a "lunated" (moon-shaped) submammary incision with provision for resection of skin in pendulous cases. He also noted the need for secondary surgery in some circumstances, stressing that primary procedures often proved inadequate. Very interestingly, Paulus emphasized the psychological factors that he felt provided indication for the surgery, stating, "Wherefore as this deformity has the reproach of effeminacy, it is proper to operate upon it."

Although several procedures for gynecomastia were described in the eighteenth and nineteenth centuries, it was the contributions of Dufourmantel and Webster in the early twentieth century that had the greatest impact on surgical treatment. Development of a surgical approach to the breast via an areolar edge incision made possible new resectional treatments that were much less disfiguring than those that had gone before. A variety of authors designed approaches that allowed skin resection with acceptable scarring, perhaps most notable being the contributions of Letterman and Schurter in 1969 and 1972. The latter operation represented a clever re-application of the "oblique" mammaplasty proposed by Dufourmentel and Mouly for woman, (see the"Gallery" for operative designs). In the late 1970's and beyond, the development and refinement of liposuction as a surgical technique has allowed for the further improvement of modern treatment modalities.

As of today, the patient with gynecomastia often has surgical options that include the use of minimally invasive techniques, and that in some instances, can produce results that appear quite normal and may even defy detection, (see "Treatment").