Gynecomastia is a benign condition involving increased breast size in males. Benign breast enlargement is characterized by an increase in breast diameter of more than two centimeters concentrically from the nipple; it may be firm or rubbery upon palpation and with regularity of the borders. Nipple discharge may also be present. The consistency and characteristic of the nipple discharge may help distinguish a benign from a malignant case. Dimpling of the breast skin, signs of inflammation such as redness and pain, or irregular appearance may raise suspicion of infection or malignancy.
Most breast enlargements in males, if proven non-pathologic and is merely due to normal hormonal changes such as in newborns and adolescents, are usually self- limiting. Observation is advised. Medical treatment (such as the use of dihydrotestorone, danazol, clompiphene or bromocriptine) may be needed, especially if no breast size reduction is observed in a minimum of two years. Increase in breast size in males accompanied by other symptoms may require further tests aside from a detailed medical history, such as liver and thyroid function tests, blood plasma measurements of sex hormones and binding proteins, and imaging to find out the underlying cause.
Other than looking for the primary reason for the breast changes, counseling and health education is important to help the affected individual cope with discomfort or anxiety. Medical management of the underlying disease is crucial. Surgical reduction mammoplasty may also be done for cosmetic purposes, since it has not yet been proven necessary; it’s also unknown whether it can treat gynecomastia without requiring other procedures and treatments.
Most health insurance companies worldwide cover only medically compulsory and emergency procedures. Cosmetic and some elective procedures have not yet been included in majority of health insurance plans. Many American-managed health care companies such as AETNA, which sells health care insurance plans and other related medical services, cover only the treatment of the primary cause of gynecomastia, as it is still recommended to treat male breast enlargement conservatively. There is insufficient evidence to prove that mammoplasty is superior to medical treatment.
Reduction mammoplasty may be covered, if the reason for the procedure is to relieve pain or suffering from massive breast size, with at least two body areas affected (such as the head, neck, back or shoulder), and that it has affected the individual’s daily life for at least one year. But generally speaking, there is no proven physical dysfunction in males with increased breast size.
Some studies done recently and in the past have tried to defend the argument of unnecessary surgical breast reduction in males, especially in male adolescents, as they are more prone to embarrassment, depression, and diminished self- confidence. However, these studies have failed to present reliable data. Well- designed and controlled clinical trials are yet to be done to support the significance of surgical intervention. Furthermore, surgery is more aggressive and the risks (such as infections and other complications) are far greater, aside from the fact that it may be more costly than conservative management.
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