The pathology of the mammary glands in the form of fibrocystic transformation is called mastopathy . This disease is classified as female, although men have similar conditions. In representatives of the stronger sex, the mammary glands are more often affected during adolescence. But sometimes painful consolidations occur at another age (including in children and seniors).
Fig. 1 - Hypertrophy of the mammary glands in men - gynecomastia (before and after surgery).
The normal structure of the mammary glands in men
Dairy (breast) glands are laid in the period of intrauterine development in both boys and girls. Until puberty (puberty), differences in the anatomical structure of this area are practically not observed. Then, in adolescent girls, glandular tissue grows under the action of estrogens, gestagens, and prolactin. Changes the volume, shape, structure of the body. In boys, the mammary glands practically do not develop. In adulthood, men have an isola of relatively small diameter and a nipple 2-4 mm in height. The mammary glands are located in the intervals between the fourth and fifth ribs to the left and right of the midline. The organ tissue (in the study of macropreparation) has a whitish color. Slices and moves are underdeveloped, short. The thickness of the breast in a man is normal - up to 5 mm, and width - up to 15 mm.
In the histological structure there are 2 sections:
- secretory (consists of epithelial ducts);
- interstitial (composed of connective tissue).
A number of hormones affect men's glandular tissue. The main role belongs to androgens, prolactin, estrogen, gonadotropins, somatotropin. At the same time, sex steroids have a greater effect on the epithelial ducts (parenchyma), and prolactin affects the interstitial tissues.
What is gynecomastia?
Breast hypertrophy in men is called gynecomastia. The increase may be due to different tissues. If the volume grows due to subcutaneous fat, gynecomastia is false. The increase in size due to glandular tissue is called the true form of this condition. Quite often, gynecomastia is considered mixed (both the glandular and fatty components are represented in the tissue (see Fig. 1)).
Fig. 2 - Gynecomastia caused by the proliferation of glandular tissue and subcutaneous fat (mixed gynecomastia).
False gynecomastia is usually found in obesity , and true and mixed are manifestations of hormonal imbalance or a serious disease.
Stages of development of gynecomastia:
- proliferation of the thoracic ducts;
- the proliferation of the glandular component;
- fibrous growth (proliferation of connective tissue).
A variant of the norm is gynecomastia:
- in newborns (determined in 50% of boys);
- in adolescents (detected in 40-60% of young men);
- in the elderly (occurs in 25-30% of men over 50 years).
Breast enlargement in newborns is associated with the effects of maternal estrogen. Usually gynecomastia occurs in the first month after the birth of the child.
Hypertrophy of glandular tissue in boys at puberty is associated with hormonal alteration of the body. Breast augmentation passes on its own in 6-24 months.
In adult young men without excess weight gynecomastia is relatively rare (10-20%).
Table 1 - The degree of hypertrophy of the mammary glands.
|1 degree||A small nodule under the areola (subareolar nodularity)|
|2 degree||Iron occupies almost all the space under the areola.|
|3 degree||The entire area of the areola is occupied by glandular tissue.|
|4 degree||The node exceeds the size of the areola and goes beyond its limits (up to 10 cm in diameter)|
These degrees are used to evaluate true and mixed gynecomastia.
Pathological causes of gynecomastia
Hypertrophy of the mammary glands in men may occur due to physiological or pathological reasons. The first group includes all natural etiological factors (aging, puberty, etc.).
Pathological reasons include:
- genetic diseases (Klinefelter syndrome);
- tumors with hormonal activity;
- thyrotoxicosis ;
- hyperprolactinemia ;
- metabolic syndrome ;
- hypogonadism ;
- renal failure;
- liver failure;
- taking certain medications;
One of the 500 newborn boys has an extra chromosome in the cells (47, XXY versus the usual 46, XY). In these children, all the signs of Klinefelter syndrome are formed in the future. They include the characteristic appearance, hypogonadism, infertility, erectile dysfunction. Also, since adolescence, patients have gynecomastia.
The most pronounced changes in the hormonal background and the appearance of gynecomastia provoke tumors of the testicle, adrenal cortex, pituitary. Such tumors can be a source of gonadotropins , estrogens, gestagens, androgens. The prolactinoma of the pituitary is also relatively common. In this case, a benign neoplasm releases excessive levels of prolactin into the blood.
Thyrotoxicosis is accompanied by gynecomastia in 20-40% of men. Excess thyroid hormones leads to activation of the reticular zone of the adrenal cortex. The endocrine cells of this region produce androgens. But these sex steroids due to thyrotoxicosis quickly undergo transformation into estrogens . As a result, the relative predominance of female steroids is formed in the body.
Excessive aromatization of testosterone in peripheral tissues also provokes metabolic syndrome (see Fig. 3). The basis of the pathology is insufficient pancreatic insulin tissue sensitivity. This condition is also often accompanied by hypogonadism. Testosterone is secreted insufficiently, since the testicles can be damaged by hyperglycemia and hypercholesterolemia, characteristic of the metabolic syndrome.
Fig. 3 - Effect of increased aromatase activity on the level of androgens in men.
Kidney disease leads to chronic intoxication of the body. The blood accumulates metabolic products. Toxic substances inhibit the production of testosterone. This leads to hypogonadism and relative hyperestrogenism.
Liver pathology has even brighter manifestations. Chronic hepatitis, fatty hepatosis, cirrhosis, and cancer can lead to organ failure. Because of these diseases, aromatase is activated in the liver tissue, which converts androgens to estrogens (see Fig. 3). The transformation process is very fast. Because of this, men acquire feminine traits and they develop gynecomastia. In severe cases, Silvestrini-Cordia syndrome develops, including testicular hypotrophy, breast hypertrophy, liver cirrhosis, low blood testosterone levels .
Fasting, stress, severe somatic diseases sometimes disrupt the hormonal balance of the male body. If estrogen becomes relatively abundant, then gynecomastia also appears.
From drugs and drugs, breast hypertrophy is provoked by:
- antiandrogens (flutamide, veroshpiron, finasteride);
- anabolic steroid;
- antiretroviral agents (efavirenz, etc.);
- sedatives (diazepam);
- chemotherapeutic agents;
- cardiac glycosides (digoxin);
- antihypertensives (calcium channel blockers);
- alcoholic beverages;
- drugs (opiates, marijuana , amphetamines, etc.).
Fig. 4 - Breast enlargement triggered by the use of anabolic steroids.
Symptoms of breast pathology in men
Symptoms of gynecomastia may be mild or fairly severe.
The main complaints in men associated with this disease are:
- swelling in the nipple area;
- nipple pain;
- discomfort and pressure in the projection of the pectoral muscles;
- discharge from the nipples;
- increased areola pigmentation;
- an increase in the volume of soft tissues in the region of the pectoral muscles.
The patient also noted the accumulation and sagging of fatty tissue in the chest. Externally, the male body begins to resemble the female (visible mammary glands are formed).
Usually the changes are bilateral, that is, the right and left glands are hypertrophied. If the increase occurs only on one side (Fig. 5), then the risk of a malignant process is higher.
Fig. 5 - Uneven breast hypertrophy may indicate a malignant process.
Examination of mastitis in men
Boys and men with first-time gynecomastia must undergo a comprehensive examination. This condition is usually benign and safe for health. In many cases, it does not require treatment. However, there are situations where breast hypertrophy occurs due to malignant neoplasms or other serious diseases that require immediate medical intervention.
Diagnostics can be conducted by a general practitioner, therapeutist, surgeon, endocrinologist, andrologist, oncologist, etc.
Standard examinations include:
- information gathering (history);
- palpation (palpation);
- ultrasound procedure;
- hormonal profile;
- blood chemistry;
An integrated approach allows to clarify the availability, nature and extent of gynecomastia, as well as its causes.
Treatment of mastitis in men
Physiological gynecomastia usually goes away on its own and does not require special treatment. In adolescence, some patients require psychological counseling to adapt to the characteristics of growing up and changes in their own body.
If endocrine diseases (thyrotoxicosis, hyperprolactinemia) have led to hypertrophy of the mammary glands, then the patient is recommended to first of all treat these pathologies.
If gynecomastia occurs due to hypogonadism, then the patient may be prescribed hormone replacement therapy with testosterone .
Surgical treatment is carried out:
- with a pronounced cosmetic defect;
- with fibrosis of the mammary glands;
- with nodal forms of the disease;
- if you suspect an oncological process.
Surgery includes mastectomy (removal of the gland) and liposuction (removal of adipose tissue).
Endocrinologist Tsvetkova I.G.