Common Breast Complaints [Gynecomastia, Breast Asymmetry, Galactorrhea]

Abstract

Gynecomastia means breast enlargement noted in males. It is mostly seen in adolescent males at the time of puberty. It is important to differentiate true gynecomastia from lipomastia especially in obese patients. Occasionally there is an associated underlying systemic or endocrine cause; hence detailed history and physical examination is warranted. If no secondary cause of gynecomastia is found, watchful waiting with regular follow-up is recommended as most cases regress spontaneously. If that is not the case, then medical treatment can be considered, although there are limited randomized clinical trials for medical management of gynecomastia in the pediatric population. Surgical referral can be considered for refractory cases of gynecomastia.

Breast asymmetry can be seen in pubertal adolescent girls and boys due to the fluctuating response of breast tissue to the hormonal environment. Some degree of asymmetry is common and almost always benign. Detailed history and physical examination are necessary to rule out any pathology. If no underlying pathology is suspected, watchful waiting until breast development is complete is reasonable. Surgical referral for cosmetic mammoplasty can be considered for significant breast asymmetry that fails to resolve.

Galactorrhea is defined as breast milk production in males, and in females a year after pregnancy or cessation of breast feeding. Several local and systemic conditions as well as medications can cause galactorrhea and are essential to rule out. Galactorrhea with normal prolactin levels can be observed without treatment. Brain imaging is required if elevated prolactin level without an underlying cause is found. Dopamine agonists are first-line medical therapy for prolactinoma. Patient should be referred to neurosurgery for central nervous system lesions other than prolactinoma.