Gynecomastia-breast abnormality in men, manifested by single-or double-sided increasetheir size through hypertrophy glandular or adipose tissue. Is a seal and an increase inbreast cancer, a sense of gravity, painful at palpation. Can regress on their own. The ineffectiveness of conservative therapy shows surgical treatment, because the long-termexistence of Gynecomastia is the risk in the development of malignant tumors of the breast.
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Gynecomastia
Classification of gynecomastia
Development mechanism and causes of gynecomastia
The symptoms of gynecomastia
Diagnose of gynecomastia
Treatment of gynecomastia
Forecast for gynecomastia
Gynecomastia-treatment in Moscow
Gynecomastia-breast abnormality in men, manifested by single-or double-sided increasetheir size through hypertrophy glandular or adipose tissue. Is a seal and an increase inbreast cancer, a sense of gravity, painful at palpation. Can regress on their own. The ineffectiveness of conservative therapy shows surgical treatment, because the long-termexistence of Gynecomastia is the risk in the development of malignant tumors of the breast.
Mammary glands in Gyno can reach from 2 up to 10 cm (about 4 cm) in diameter.Frequency of occurrence of Gynecomastia varies from 50 to 70% among healthyadolescents 13-14 years, about 40% of men of young age, up to 60%-70%-in older men.Gynecomastia is male physical discomfort and psychological difficulties.
Classification of gynecomastia
GinekomastiâRazličaût true Gynecomastia and false (or psevdoginekomastiû). TrueGynecomastia is characterized by glandular tissue hypertrophy and stroma,psevdoginekomastiâ due to the massive deposits of body fat, increase the amount ofmammary glands, and is seen in men with obesity.
Meets the true Gynecomastia, as a variant of the physiological norm in certain age periods,and pathological Gynecomastia, which is a symptom of serious diseases in the body.
True idiopathic (physiological) Gynecomastia can be of three types:
Gynecomastia the neonatal period is swelling of the mammary gland in 60-90% of newborns. This condition is caused by the influence of sex hormones in the mother's bodyof the child is still in utero. The treatment does not require breast gland shrinks over 2-4weeks.
Gynecomastia-puberty occurs in 30-60% of adolescents in the 13-14 years of age; in 80% of cases are bilateral increase of glands. Due to immaturity of the male reproductive systemand the predominance of female sex hormones on men. Usually regresses on its own within1-2 years.
Gynecomastia is seen in older men 50-80 years because of reduced production of testosterone and estrogen dominance.
When Gynecomastia may be bilateral symmetrical increase in both breasts (80%) of the orasymmetrical increase one gland.
Development mechanism and causes of gynecomastia
Normal mammary glands in men are underdeveloped, rudimentary body consisting of a small amount of glandular tissue and fat, short ducts and nipples. Development and operation of mammary glands depends on the effects of female sex hormones-estrogen and pituitary hormone-prolactin. OK in the male body the amount of estrogen is less than 0.001% of the content of the androgen, and they are quickly destroyed by the liver. For a number of reasons, the percentage of androgens/estrogen changes upwards or decrease the sensitivity of tissues to the action of testosterone. Under the influence of estrogen starts the development and growth of male breast cancer in female type with intensive development of glandular tissue. With the development of the pituitary adenoma, producing prolactin in breast is the deposition of fat and connective tissue. When Gynecomastia breasts increase in size and compacted.
True pathological Gynecomastia in men can be caused by any of the following groups ofcauses:
violation of the relationship of testosterone and estrogen in the male body. This condition may occur when hormonally active tumors of the pituitary gland, testes, adrenal, stomach, pancreas, lung, primary and gipogonadizme age (insufficient functioning of the sex glands),prostate adenoma, inflammatory processes in the testes, addisonovoj diseases, etc.;
giperprolaktinemij-increase secreting prolactin pituitary tumors, gipoterioze;
diseases causing impaired metabolic processes-with diffuse toxic goiter, diabetes, obesity,tuberculosis of lungs, etc.;
diseases neèndokrinnoj nature-in poisonings, cirrhosis of the liver, kidney or heart problems, HIV infection, chest trauma, thoracic, defeat gerpetičeskom normalization ofpower supply after depletion, etc.;
taking drugs acting on receptors in the breast tissue that increase production of estrogenor hormone blockers receptors of gonadotropins, which have toxic effects on the testes, etc. (corticosteroids, anabolic steroids, cimetidine, spironolactone, isoniazid, metronidazole, ranitidine, captopril, enalapril, reserpine, metildofa, nifedipine, Verapamil, amiodarone,digitoksin, antidepressants, theophylline, methadone, diazepam creams containingestrogen, etc.;
the use of drugs (geroinomaniâ, marijuana use) and alcoholism.
The symptoms of gynecomastia
During the neonatal period is slight Gyno bloating and breast augmentation, sometimeswith molozivopodobnymi secretions.
Other forms of Gynecomastia breasts can grow from 2 up to 10-15 cm in diameter and reach up to 160 g weight Increases the nipple, the areola becomes dramatically pigmentedand extended up to 2-3 cm in diameter. In rare cases there are the dairy kind of discharge from the nipple. Enlarged glands usually are painless, may be feeling the pressure nipplesensitivity, discomfort when wearing clothes.
When unilateral Gynecomastia increases the chance of the tumor lesion of breast cancer.Hormonally active tumors that produce estrogen and human chorionic gonadotropin,causing a rapid increase in mammary glands, their pain and a feeling of bloating.
Gynecomastia due giperprolaktinemiei, accompanied by oligospermiei, impotence andsymptoms of central nervous system.
During Gyno emit three stages:
developing (proliferiruûŝuû)-the initial change, the first 4 months, when perhaps the opposite development of Gynecomastia with appropriate medical treatment;
the staging is characterized by maturing the glandular tissue; from 4 months to a year;
fibrous-celebrated appearance in the thoracic gland connective and adipose tissue;regression of the disease process is almost impossible.
The bleeding from the nipple, gaskets in the prostate gland, skin changes, ulceration,enlarged axillary forced to suspect breast cancer.
Diagnose of gynecomastia
Primary survey on Gyno patient's tour of the palpation of the mammary glands and testes,assess the severity of secondary sexual characteristics, figuring the family, medical historyand current medical conditions, the availability of alcohol and drug addiction.
Signs of Gynecomastia is endocrinologist's consultation. Scope of laboratory Diagnostics,which today has to be thoroughly Endocrinology, hormonal examination of the patient.Laboratory-determined blood levels of estradiol, testosterone, LH, FSH, prolactin,tireotropina, HCG, liver transaminaz, nitrogen, creatinine, urea.
To remove a lung x-ray tumor processes, CT CT SCAN of the brain, adrenal, etc. bodies (if indicated).
In case of neoplastic lesions of the testicles (increasing the content of human chorionic gonadotropin and testosterone) is ultrasound of the scrotum. To determine the nature of Gynecomastia (true or false), detection of breast tumor using breast ultrasound. AxillaryULTRASOUND mammography and breast biopsy is performed in cases of suspectedcancer.
Treatment of gynecomastia
Physiological types of Gynecomastia usually disappear spontaneously and require nomedical correction.
Sometimes for high concentrations of estrogen at physiological Gynecomastia in adolescents can be prescribed hormonal drugs: clomiphene, tamoxifen, danazol, dihydrotestosterone, testolactone. If the medication does not reduce breast size, it comes to the aid of plastic surgery. The removal of breast tissue and liposuction (FAT removal incontiguous zones).
Treatment of pathological Gynecomastia depends on underlying medical condition that caused the breast augmentation.
To normalize the balance of testosterone and estrogen in the Gyno a conservative hormone therapy testosterone. It is effective in the first 4 months. After the occurrence of gynecomastia. With an excess of estrogen in the male body appointed antièstrogennuûtherapy with tamoxifen, blocks the effect of estrogen on breast.
Gynecomastia caused by taking drugs, usually spontaneously disappears after drug withdrawal.
Operative treatment for Gynecomastia is performed when conservative therapy is ineffectiveor obviously clear that drug treatment will not produce the desired result (when tumorlesions). Surgical treatment of Gynecomastia are the following types of operations: is the removal of breast tissue and rebuild its physiological path. Apply the following types of operations:
subcutaneous mastectomy with preservation of the areola of paraareolârnogo access;
subcutaneous mastectomy paraareolârnogo of access with liposuction;
Endoscopic mastectomy (at low magnifications of the breast).
Subcutaneous mastectomy and endoscopic operations are well tolerated by patients, do not require prolonged hospitalization (usually 2 days) and long-term rehabilitation. The first2-3 weeks after mastectomy wear elastic waist underwear is required to generate theproper outline of muscle and reduction of skin. After 5-7 days you can begin normal operations and a month-to sports training.
Forecast for gynecomastia
Gynecomastia newborns and teenagers is characterized by a favourable current. In postpubertatne period Gynecomastia disappears within 2 years at 75% of boys in the next 3years is still at 15%.
The outcome in pathological forms of Gynecomastia depends on whether the removal of the cause of the disease. Prognostically more favorable drug Gynecomastia, less-Gynecomastia caused by chronic diseases.
For a long period of Gyno increases the likelihood of breast cancer in men.
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