Abstract

Aim: Gynecomastia is defined as an increase in the stromal and ductal components of the male breast due to an imbalance between the effects of free estrogen and testosterone which affects adolescents commonly. The aim of this study is to determine the causes of breast masses in young males and adolescents and to test the hypothesis that gynecomastia will be smaller and less frequent in adult males than adolescents due to the regulation of hormone levels after adolescence.

Methods: Breast ultrasound imaging studies between January 2014 and October 2019 were reviewed and a total of 345 male patients between 9-20 and 21-35 years of age were included in the study. Lesions were classified as normal male breast appearance, unilateral gynecomastia, bilateral gynecomastia, increased subcutaneous-adipose tissue (pseudogynecomastia), lipoma, suspicious lesion, and other benign findings as infection. Sizes of fibroglandular tissue were reported and compared between age groups. Statistical analysis of lesion types and patient groups was performed by the Chi-square test. Patient age and gynecomastia status were analyzed by Student’s t-test. Patient age and size of gynecomastia were compared by the Spearman correlation test.

Results: Two hundred and eight young males and 137 adolescents formed the study group. Sixty percent of the adults and 77.6% of the adolescents had gynecomastia. The second most common pathology was pseudogynecomastia in 17% of the young adults and, 12% of the adolescents. One suspicious lesion was found in the adult group and the pathology revealed gynecomastia. Gynecomastia was found to be more common in the adolescent group (P<0.01). the sizes of the glandular tissues were not significantly different between adolescents and young adults and according to age.

Conclusion: Gynecomastia is more common in adolescents, mostly bilateral, than in young adults. However, the size of the glandular tissue does not differ between age groups. We cannot conclude that gynecomastia in adults is prone to be smaller than in adolescents due to the regulation of hormones after adolescence.

Keywords: Adolescence, breast ultrasound, gynecomastia, male breast

Copyright and license

Copyright © 2023 The Author(s). This is an open-access article published by Bolu İzzet Baysal Training and Research Hospital under the terms of the Creative Commons Attribution License (CC BY) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Günbey Karabekmez L, Yağdıran B, Çetin M, Karabekmez FE. Ultrasonographic findings in young men with breast masses: Changes in adolescence and young adulthood. Northwestern Med J. 2023;3(2):88-95. https://doi.org/10.54307/NWMJ.2023.30085

References

  1. Aslan Ö, Bayraktaroğlu S, Çinkooğlu A, Ceylan N, Savaş R, Oktay A. Prevalence of Incidental Gynecomastia by Chest Computed Tomography in Patients with a Prediagnosis of COVID-19 Pneumonia. Eur J Breast Health. 2021; 17(2): 173-9. https://doi.org/10.4274/ejbh.galenos.2021.6251
  2. Charlot M, Béatrix O, Chateau F, et al. Pathologies of the male breast. Diagn Interv Imaging. 2013; 94(1): 26-37. https://doi.org/10.1016/j.diii.2012.10.011
  3. Michels LG, Gold RH, Arndt RD. Radiography of gynecomastia and other disorders of the male breast. Radiology. 1977; 122(1): 117-22. https://doi.org/10.1148/122.1.117
  4. Reinehr T, Kulle A, Barth A, Ackermann J, Holl RW, Holterhus PM. Transition from gynaecomastia to lipomastia in pubertal boys. Clin Endocrinol (Oxf). 2021; 94(4): 583-9. https://doi.org/10.1111/cen.14403
  5. Venkata Ratnam B. How important is “pseudogynecomastia”? Aesthetic Plast Surg. 2011; 35(4): 668-9. https://doi.org/10.1007/s00266-010-9629-0
  6. Koch T, Bräuner EV, Busch AS, Hickey M, Juul A. Marked Increase in Incident Gynecomastia: A 20-Year National Registry Study, 1998 to 2017. J Clin Endocrinol Metab. 2020; 105(10): dgaa440. https://doi.org/10.1210/clinem/dgaa440
  7. Stewart RA, Howlett DC, Hearn FJ. Pictorial review: the imaging features of male breast disease. Clin Radiol. 1997; 52(10): 739-44. https://doi.org/10.1016/s0009-9260(97)80151-1
  8. Billa E, Kanakis GA, Goulis DG. Imaging in gynecomastia. Andrology. 2021; 9(5): 1444-56. https://doi.org/10.1111/andr.13051
  9. Gilda C. The male breast. In: Gilda C, editor. Breast imaging companion. 2 ed. Philedelphia: Lippincot Williams & Wilkins; 2001: 401-8.
  10. Chen L, Chantra PK, Larsen LH, et al. Imaging characteristics of malignant lesions of the male breast. Radiographics. 2006; 26(4): 993-1006. https://doi.org/10.1148/rg.264055116
  11. Kanakis GA, Nordkap L, Bang AK, et al. EAA clinical practice guidelines-gynecomastia evaluation and management. Andrology. 2019; 7(6): 778-93. https://doi.org/10.1111/andr.12636
  12. Kopans DB. The male breast. In: Kopans DB, editor. Breast Imaging. Philedelphia: Lippincot Williams & Wilkins; 2002: 671-91.
  13. Draghi F, Tarantino CC, Madonia L, Ferrozzi G. Ultrasonography of the male breast. J Ultrasound. 2011; 14(3): 122-9. https://doi.org/10.1016/j.jus.2011.06.004
  14. Stavros T. Evaluation of Male Breast. Breast Ultrasound. Philadelphia: Lippincott Williams & Wilkins; 2004: 712-41.
  15. Brookman RR. The age of “adolescence.” J Adolesc Health. 1995; 16(5): 339-40. https://doi.org/10.1016/S1054-139X(95)00071-Y
  16. Colarusso CA. Adolescence (Ages 12-20). Child and Adult Development. Boston, MA: Springer; 1992. https://doi.org/10.1007/978-1-4757-9673-5_7
  17. Klein KO. Precocious puberty: who has it? Who should be treated? J Clin Endocrinol Metab. 1999; 84(2): 411-4. https://doi.org/10.1210/jcem.84.2.5533
  18. Ma NS, Geffner ME. Gynecomastia in prepubertal and pubertal men. Curr Opin Pediatr. 2008; 20(4): 465-70. https://doi.org/10.1097/MOP.0b013e328305e415
  19. Klinger M, Bandi V, Giannasi S, et al. Gynecomastia: Ultrasound-Confirmed Classification Pertainent to Surgical Correction. Aesthetic Plast Surg. 2021; 45(4): 1397-403. https://doi.org/10.1007/s00266-021-02187-6
  20. Brown RH, Chang DK, Siy R, Friedman J. Trends in the Surgical Correction of Gynecomastia. Semin Plast Surg. 2015; 29(2): 122-30. https://doi.org/10.1055/s-0035-1549053
  21. Mathew J, Perkins GH, Stephens T, Middleton LP, Yang WT. Primary breast cancer in men: clinical, imaging, and pathologic findings in 57 patients. AJR Am J Roentgenol. 2008; 191(6): 1631-9. https://doi.org/10.2214/AJR.08.1076
  22. Johnson RE, Murad MH. Gynecomastia: pathophysiology, evaluation, and management. Mayo Clin Proc. 2009; 84(11): 1010-5. https://doi.org/10.1016/S0025-6196(11)60671-X