Gynecomastia, a glandular proliferation in the male breast, is a common clinical condition that
may occur in males of all ages. “Gynecomastia” is derived from the Greek terms gynec (female)
and mastos (breast) and was first coined by Galen in the second century AD. The condition may
be an incidental finding on routine physical examination, or may present as new-onset palpable
breast mass with or without mastalgia. It can be unilateral, bilateral, and/or asymmetrical.
Pseudogynecomastia (fatty breasts) is commonly seen in obese males and differs from
gynecomastia in that breast enlargement is due to increased fat deposition without glandular
proliferation. Gynecomastia may cause significant embarrassment and psychological distress in
affected males. In this article, the focus is on pubertal gynecomastia and review the medical and
surgical approaches to managing male adolescents with this condition.

During the life span, three phases of occurrence of gynecomastia have been observed,
corresponding to times of hormonal changes. The first peak is found during the neonatal period,
when an estimated 60 to 90% of infants develop transient palpable breast tissue because of the
transplacental passage of estrogens.The second peak occurs during puberty, when an
incidence range of anywhere between 4 to 69% of palpable breast tissue and an increase in
breast size has been reported. The third and last peak of occurrence is found later in life, with
the highest prevalence among adults between the ages of 50 and 80 years.

The etiology of gynecomastia remains unclear. Most cases of gynecomastia are thought to
result from an imbalance between estrogens and androgens.Pathological gynecomastia is rare
in adolescents and prepubertal-aged boys. It is related to conditions where absolute or relative
estrogen excess is present:

1)with exogenous intake
2) with endogenous production, or
3) with increased peripheral conversion of androgens to estrogens secondary to abundant
aromatase activity, androgen deficiency, or androgen insensitivity.

These are common mechanisms for gynecomastia secondary to medications, adrenal and
testicular neoplasms, Klinefelter syndrome, Peutz-Jeghers syndrome, thyrotoxicosis, cirrhosis,
primary hypogonadism, congenital adrenal hyperplasia, androgen insensitivity, malnutrition, and
aging.3,14 Furthermore, there are conflicting results regarding the presence of a correlation
between gynecomastia and obesity.

When an underlying hormonal disorder is identified as the cause of gynecomastia, appropriate
treatment should be sufficient to cause regression of breast tissue enlargement. In cases of
drug-induced gynecomastia, stopping the offending medication will usually cause regression.
Most commonly, the health care provider will be consulted by adolescent boys presenting with
pubertal gynecomastia. It is found to be self-limited in 75 to 90% of adolescents and regresses
over time. Observation and reassurance are widely regarded as the safest and most reasonable
treatment. However, because gynecomastia in adolescents occurs at a sensitive time when
boys are increasingly aware of their self-image, health care providers may be questioned by the
patient and/or his family about the role of pharmacological or surgical therapies in gynecomastia
surgical treatment in Jaipur.

Pubertal gynecomastia is usually self-limited. In evaluating adolescents with gynecomastia, a
comprehensive medical history and careful physical examination should be completed. In the
majority of cases, observation and reassurance will suffice. Cases of pathological gynecomastia
in adolescents and prepubertal gynecomastia are rare. In these two scenarios, further
investigation should always be undertaken to rule out an endocrine disorder. When
gynecomastia in adolescents persists for more than one year, surgical management may be
considered. The gynecomastia surgical treatment in Jaipur is faced with a range of excisional
and liposuction techniques, and the choice of incision and procedure(s) depends on the severity
of breast enlargement, the presence of skin excess, and surgeon and patient preference. The
method of choice will restore the male chest shape and address skin excess with short,
inconspicuous scars. Overall, gynecomastia surgical treatment in Jaipur appears to provide
satisfactory results, although no formal patient-reported outcomes data are available.
Pharmacological treatment is not recommended for adolescents suffering from gynecomastia,
based on the paucity of data on risks and benefits.

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