Gynaecomastia

 

Gynaecomastia is common and is thought to be present in at least a third of men in the course of their lifetime.  There can be many causes of gynaecomastia including physiological causes:  asymptomatic gynaecomastia is reported as 60-90% of neonates and is as a result of maternal oestrogens, and usually resolves over a few weeks.  Asymptomatic gynaecomastia is also reported in 50-60% of adolescents, and usually starts around the age of 14, may be unilateral and tender, and often resolves spontaneously within one to two years.  Gynaecomastia can also be caused by a decline in testosterone levels and/or an increase in oestrogen levels (both can be due to a number of factors), as well as a side effect of certain medications, with medications being the cause in up to 25% of all cases in adult men

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Definition

Benign proliferation of male breast glandular tissue

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Exclude Red Flag Symptoms

Exclude the following red flag symptoms:

  1. Unilateral firm subareolar mass not typical of gynaecomastia with or without nipple distortion or associated skin changes
  2. Unilateral eccentric mass

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NOTE:  Investigations should include alpha Feto-protein, Beta HCG if referred on a rapid referral pathway

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Management

  1. If red flag symptoms are present, refer on a rapid referral pathway
  2. Distinguish from pseudo gynaecomastia (excess of adipose tissue) and advise weight loss as appropriate
  3. Common in adolescent boys and one side can be bigger than other. Spontaneous resolution is quite likely. Reassure the patient and reassess
  4. Discontinue any gynaecomastia-inducing medication
  5. Refer only if very large or medically induced – otherwise treated as cosmetic surgery

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Important Information

  1. Ascertain what the patient is looking for from the referral e.g. reassurance, surgical correction
  2. Inform the patient that correction of gynaecomastia is not routinely funded within the local NHS for any patient group

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Advice and Guidance is being made available for all specialties, and is being provided by consultant specialists at East Kent Hospitals.  To make a request or to check to if a query has been answered, you will need to log in via the electronic Referral System (eRS)

Click here for the "how to access" e-Referral Advice and Guidance Manual for instructions on how to make a request and check responses

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