In boys and men with breast enlargement, it is important to differentiate gynaecomastia from pseudogynaecomastia and male breast cancer and to identify any treatable or serious underlying conditions.
The challenge in patients with suspected gynaecomastia is to sort the wolves from the sheep – that is, to differentiate patients with male breast cancer or gynaecomastia caused by serious underlying pathology from patients with physiological gynaecomastia or reversible aetiologies. Physiological gynaecomastia occurs in neonates, boys during puberty and older men. However, pathological gynaecomastia can present at any age and needs careful exclusion. If gynaecomastia is both longstanding and asymptomatic, and careful evaluation does not reveal abnormalities then reassurance may be the only management required.
Picture credit: © Ian Hooton/SPL