Gynecomastia

The gynecomastia is one - or bilateral high-quality increase in mammary glands at men. Distinguish a false and true form of pathology. In the first case the gynecomastia is caused by fatty deposits at the excess weight, in the second – growth of tissue of mammary gland.

Reasons and symptoms of a gynecomastia

The true gynecomastia at men is caused by the following reasons:

• Ratio distortion of estrogen and testosterone in an organism. Such state is often observed at insufficient functioning of gonads, hormonal and active tumors of testicles, a hypophysis, adrenal glands, lungs, a pancreas and stomach, and also at an addisonovy disease, inflammatory processes in testicles and adenoma of a prostate;
• Giperprolaktinemiya – increase in secretion of hormone of prolactin at a hypothyroidism and tumors of a hypophysis;
• The diseases connected with disturbance of exchange processes (obesity, a diabetes mellitus, a diffusion toxic craw, etc.);
• Other diseases of not endocrine character (cirrhosis, cardiovascular or renal failure, injuries of a thorax, HIV infection, etc.);
• Reception of a number of drugs which influence receptors of ferruterous fabric raise products of prolactin or estrogen, have toxic effect on testicles, etc. The gynecomastia in men is caused by anabolic steroids, metronidazole, corticosteroids, enalapril, verapamil, Cimetidinum, the creams containing estrogen, and many other means;
• Alcohol intake and drugs (marijuana, heroin).

The most characteristic symptom of a gynecomastia – increase in fabric of chest gland and emergence of consolidations in it. Sometimes at touch there are painful feelings which periodically decrease and disappear absolutely.

Diagnosis of pathology

Before removal of a gynecomastia, or its treatment, initial inspection which includes is necessary:

• Primary survey of the patient;
• Assessment of extent of development of secondary sexual characteristics;
• Palpation of testicles and mammary glands;
• Clarification of the family and medicinal anamnesis;
• The analysis of the available diseases;
• Detection of alcohol or drug addiction.

If gynecomastia signs are found, consultation of the endocrinologist, and also careful hormonal inspection is required. Determine by methods of laboratory diagnosis the content in blood of such hormones as: testosterone, oestradiol, thyrotropin, prolactin, CGP (chorionic gonadotrophin of the person), FSG (follicle-stimulating hormone) and LH (luteinizing hormone).

(False or true) apply ultrasonography of mammary glands to detection of a tumor of a breast and definition of character of a gynecomastia.

Conservative treatment of a gynecomastia

At the first stage of a disease (within four months after the beginning of growth of ferruterous fabric) it is possible to reduce the volume of mammary glands by methods of conservative therapy. At the same time it is rather simple to get rid of a gynecomastia without operation. The hormonal therapy normalizing balance of testosterone and estrogen, and as a result, promoting reduction of mammary glands is for this purpose appointed.

At conservative treatment of a gynecomastia use the following drugs:

• Anti-oestrogenic means (for example, Tamoxifenum). They are appointed in case of the excess content of estrogen in a male body. Anti-estrogen blocks this subclass of steroid hormones and does not allow them to influence mammary glands. Use of such drugs, despite their efficiency, is limited to numerous side effects;
• Testosterone is a male sex hormone which is appointed at decrease in its level in an organism. Positive effect of drug is especially noticeable at a hypogonadism which is characterized by insufficient secretion of androgens at an underdevelopment or damage of gonads. However at a physiological teenage gynecomastia at men purpose of testosterone is not always effective.

Surgical treatment of a gynecomastia

In cases when conservative therapy does not yield desirable result or it is initially clear that drug treatment will not help (for example, at tumoral defeats), an operative measure is carried out. During surgical removal of a gynecomastia excision of chest gland and the subsequent recovery of its physiological contour is carried out.

Indications to operational treatment are:

• Large volume of ferruterous fabric;
• Pronounced cosmetic defect;
• Age of pathology over a year.

Operations at a gynecomastia happen the following types:

• Endoscopic mastectomy through a section in axillary area (at small increase in mammary glands);
• Hypodermic mastectomy from a periareolyarny section with preservation of an areola;
• Hypodermic mastectomy with liposuction.

An operation on removal of a gynecomastia is well undergone by patients and does not demand long hospitalization and rehabilitation. In the first days after it hematomas and small hypostasis, and also a sensation of discomfort in a breast can be observed. For 2-3 weeks after surgical intervention it is recommended to wear the special dragging-away linen which helps to reduce skin and to create the correct muscular contour. Within a month it is necessary to exclude exercise stresses. The recovery period for each patient is individual, and the final result is swept up approximately in 12 weeks.

Contraindications to removal of a gynecomastia and operation following:

• Disturbance of coagulability of blood;
• Arterial hypertension;
• Endocrine diseases;
• Heavy pathologies of cardiovascular system;
• Oncological and infectious diseases;
• Breast injuries;
• Low contractility and elasticity of skin.

At long existence of a gynecomastia the risk of development of cancer of mammary glands increases. Therefore if in the presence of this pathology bloody allocations from nipples appear, consolidations are formed, skin over education changes, axillary lymph nodes increase, it is necessary to see a doctor urgently.