Breast Problems:

Gynecomastia (large male breast):

Gynecomastia is the benign enlargement of breast tissue in males. It isn’t a serious problem. 

Causes:              

The exact cause of Gynecomastia is unknown.

Newborns, boys going through puberty and older men may develop gynecomastia as a result of normal changes in hormone levels, though other causes also exist. Half or more of adolescent boys have some breast development during puberty.

Gynecomastia may arise as an abnormal condition associated with disease or metabolic disorders, as a side-effect of medication, or as a result of the natural decrease of testosterone production in older males, by excessive estrogen actions an increased ratio of estrogen to androgen

Medications include: ketoconazole, cimetidine, gonadotropin-releasing hormone analogues, human growth hormone, human chorionic gonadotropin, antiandrogens such as bicalutamide, flutamide, and spironolactone, and 5-alpha-reductase inhibitors such as finasteride or dutasteride.

Other causes of male breast enlargement such as mastitis, breast cancer, pseudogynecomastia, lipoma, sebaceous cyst, dermoid cyst, hematoma, metastasis, ductal ectasia, fat necrosis, or a hamartoma.   

In some cases it may be an indicator of other more serious underlying conditions, such as testicular cancer.

Clinical Features:

Gynecomastia may occur unilaterally or bilaterally, sometimes unevenly presenting with swollen breast tissue or breast tenderness, which may lead affected individuals to be concerned about the possibility of having breast cancer.

An increase in the diameter of the areola or asymmetry of chest tissue are other possible signs of Gynecomastia

Diagnosis:

Usually Clinical Diagnosis is enough. In doubtful cases,

We can do some investigation as per need

Treatment:

Most cases of newborn gynecomastia are self-limiting and resolve on their own.

75% of pubertal gynecomastia cases resolve within two years of onset without treatment.

Adolescent Gynecomastia may resolve without any medication also.

If the problem not resolved normally, treatment is surgical – subcutaneous mastectomy, liposuction-assisted mastectomy, laser-assisted liposuction, and laser-lipolysis without liposuction.

Complications of mastectomy:

Hematoma, wound infection, breast asymmetry, changes in sensation in the male breast, necrosis of the areola or nipple, seroma, noticeable or painful scars, and contour deformities

Macromastia/ Hypertrophy of breast: Excessively large  Female breasts.

Treatment: Breast Reduction (Reduction mamoplasty)

Breast asymmetry: Sometimes female breasts may develop asymmetrically.

Treatment: As per need.

Breast atrophy (Small Breast): In female breast may be smaller in size according to her age and body.

Treatment: Mamoplasty – artificial (Silicon) breast implant may need.

Chest Wall Defects:

Congenital chest wall deformity can be categorized as either rib cage overgrowth or deformities related to inadequate growth (aplasia or dysplasia). Rib cage overgrowth leads to depression of the sternum (pectus excavatum) or protuberance of the sternum (pectus carinatum)-accounts for more than 90% of congenital chest wall deformities. The remaining deformities are a result of inadequate growth like sternal cleft.

Treatment: Correction of chest deformities by Surgery.