Gynecomastia: What the Surgeon Needs to Know

Carol J. Singer-Granick, MD; Mark S. Granick, MD


ePlasty. 2009;9:41-51. 

In This Article

Abstract and Description


Objective: The purpose of this review is to present the complex underlying pathophysiology that can form the basis of this common condition.
Methods: More than 20 years of clinical experience in endocrinology and plastic surgery and a review of the English-language literature were used to form the basis of this review.
Results: While idiopathic and physiologic causes are frequent, there are multiple, significant, underlying disorders that can result in gynecomastia, including chronic illness, cancer, medications, syndromes, and a variety of endocrinopathies.
Conclusion: Both history and physical examination are frequently sufficient to make an appropriate diagnosis. In patients who do not have a definitive etiology of their gynecomastia, a screening battery of laboratory tests is sufficient to rule out significant pathophysiology, although these tests may be difficult to interpret in children and adolescents. An endocrinology consultation is suggested whenever an abnormal screening laboratory test occurs or if there are any other suggestions of underlying endocrinopathy.


Gynecomastia refers to the condition of breast development in a male. It can occur in boys and men of all ages and is most common in infancy and adolescence and in middle-aged to older men. The pathophysiology of gynecomastia is felt to be an imbalance of estrogens and androgens, with a decreased testosterone-to-estradiol ratio.[1] This imbalance can occur through many mechanisms and directly affects breast tissue.[2] Transient gynecomastia is estimated to occur in 60% to 90% of male infants secondary to high estrogen state during pregnancy.[3,4] Pubertal gynecomastia has a peak prevalence of nearly 65% and occurs at about 14 years of age.[3,5] Older men also develop involutional gynecomastia, with a prevalence of 40% to 55%, seen at autopsy.[6] Frequently, the etiology of gynecomastia is evident when a thorough history and physical examination are performed. When the etiology is not apparent, then a series of laboratory tests should be performed to rule out significant underlying pathophysiology.