A Diagnostic Algorithm for Male Adolescent Breast Hypertrophy: A Systematic Review
Joseph M. Firriolo, MD; Laura C. Nuzzi, BA; Catherine T. McNamara, BS; John G. Meara, MD, DMD, MBA; Brian I. Labow, MD Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Background:
Gynecomastia, the benign proliferation of male glandular breast tissue, occurs in up to 80% of adolescents. Most cases are idiopathic and resolve without intervention; persistent cases (>3 years) are often treated with surgical resection. However, before proceeding with operative intervention, pediatricians and surgeons must: 1) screen for conditions that mimic gynecomastia, and 2) rule out causes of secondary gynecomastia. The purpose of this study is to develop a diagnostic algorithm for male adolescent breast hypertrophy.
Methods:
We performed a comprehensive literature review and selected articles relevant to the diagnosis and management of idiopathic and secondary male adolescent breast enlargement.
Results:
A total of 203 English language articles from 2008-2018 were identified from a PubMed query. 111 articles met the inclusion criteria, describing elements of the diagnostic approach to gynecomastia and the treatment options for the various causes of male breast enlargement. Non-gynecomastia causes of male breast enlargement include pseudogynecomastia (lipomastia) and malignancy. Secondary causes of gynecomastia include endocrine disease, anabolic steroid use, alcohol intake, various prescription drugs, and possibly marijuana use.
Conclusion:
Idiopathic, transient gynecomastia represents the majority of adolescent male breast enlargement. Plastic surgeons are often called to operate on patients with persistent gynecomastia. However plastic surgeons should first rule out pseudogynecomastia and malignancy and address all possible modifiable factors that may contribute to the development of secondary gynecomastia.
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