GYNAECOMASTIA: MANAGEMENT IN A DEVELOPING COUNTRY
Abstract
Background: Gynaecomastia is a benign enlargement of male breast. It is common in the generalpopulation, resulting from various pathophysiological mechanisms. The aim of this study was to
describe the presentation and outcome of treatment for gynaecomastia at a University Hospital in
Pakistan. Methods: A three year retrospective study was carried out of one hundred men with
gynaecomastia. Patients were evaluated in detail clinically and by appropriate investigations. They were
counselled and kept on hormonal therapy for three months. Surgery was considered for patients with
long standing gynaecomastia, failed medical therapy and for cosmetic reasons. Post operative
complications and patient's satisfaction was assessed. Results: Most (90%) cases were idiopathic.
Other causes were liver cirrhosis in 4 cases, testicular tumour in two, thyrotoxicosis in one and drug
induced (use of cimetidine and Kushta) in two. Carcinoma of the breast was diagnosed in one patient.
Most of the patients had bilateral, non tender lump in the breast. Three cases of idiopathic
gynaecomastia resolved on danazol. Eighty-eight cases underwent surgical treatment. The mean age of
patients who underwent surgery (n=88) was 30.5±9.59 years. Most of the patients belonged to 21-30
years age group. Major indications for surgery were failure of medical treatment (45.5%) and cosmetic
reasons (34.0%). Mean operating time for subcutaneous mastectomy was 42.2±3.70 (36-48) minutes.
Mean hospital stay after subcutaneous mastectomy was 5.2±2.44 (2-10) days. The only postoperative
complication noted was wound infection (24%). Seventy-two (81.8%) were satisfied with the results of
their surgical treatment. Conclusion: Gynaecomastia is the common condition affecting male breasts
and most common cause of gynaecomastia is idiopathic. Secondary gynaecomastia may regress in size
by treating the primary cause. Idiopathic gynaecomastia do not respond to danazol so they needed
surgical treatment. Subcutaneous mastectomy through a periareolar skin incision is a valid procedure
for treatment for gynaecomastia and provides satisfactory cosmetic results.
Keywords: Gynaecomastia, Male breast, Management, Subcutaneous mastectomy
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