Gynecomastia is a clinical condition in which abnormal development of male breast tissue and abnormal hyperplasia of the connective tissue of the breast are caused by an imbalance in the ratio of estrogen to androgen due to physiological or pathological factors. It usually presents as a painless progressive enlargement of the breast or a deep disc-shaped mass in the areola, sometimes accompanied by pain or tenderness, and may also have milk-like discharge, and is the most common benign disease of the male breast.
It is the most common benign disease of the male breast, with an incidence of up to 10% in young men. Male breast development is generally divided into three types ① glandular type, where the enlarged breast is mainly enlarged by the breast parenchyma; ② fatty type, where the enlarged breast is mainly enlarged by the fatty tissue; ③ glandular fatty type, where both the breast parenchyma and fatty tissue are enlarged in the enlarged breast. The temporary gynecomastia in adolescence usually does not require treatment or only oral medication. Persistent or post-pubertal gynecomastia requires aggressive management. In patients with a definite pathogenic factor, a combination of medication along with removal of the primary cause may be more effective in eliminating the symptoms of breast enlargement. Internal therapy is most effective for gynecomastia in the split hyperplasia stage of puberty, and tartamoxifen and other treatments are effective. If medical treatment does not work over a period of time, or if the breast has been enlarged for many years and has become a significant emotional burden for the patient, surgical removal of the enlarged breast gland may be required. There are three surgical treatments for gynecomastia: liposuction, open excision, and skin reduction. After liposuction, the degree of denseness of the breast tissue needs to be reevaluated and open excision is required if there are residual masses or firm nodules. After liposuction and open excision, the amount of excess skin to be removed depends on the elasticity of the skin. If significant excess skin is still present, most often in extra large breasts or in patients with poor skin elasticity, excess skin excision is required.