Paper Title: Management of Gynaecomastia: Port Harcourt Experience
Authors: Jamabo R., Elenwo S.
BACKGROUND: Gynaecomastia is a benign enlargement of male breast glandular tissue and it is the most common breast condition in males. Most cases of gynaecomastia are benign and of cosmetic, rather than clinical, importance. At least 30 - 35% of males are affected during their life time. However, as it causes so much anxiety, psychosocial discomfort and fear of breast cancer, early diagnostic evaluation is important. AIM: The aim of this study is to describe the management and the treatment outcome of this condition in a developing country. METHOD: This is a five year retrospective study, from December, 2009 to December, 2014, in which all men who presented in the breast clinic of the hospital with history of breast lump or breast enlargement were evaluated. Out of the 21 that fell into this category, only 14 had gynaecomastia. The rest were either skin or subcutaneous lesions like lipoma, sebaceous cyst, haemangioma etc. Their detailed histories including past medical, surgical, drug histories and their clinical findings as recorded in their case notes as well as the appropriate investigations carried out were obtained. RESULTS: Nine (9) (64.3%) cases were idiopathic. Three (3) (21.4%) cases had testicular atrophy and they were bilateral. One case (7.1%) had carcinoma of the breast and it was unilateral. Five (5) (55.6%) of the idiopathic patients had bilateral disease while the remaining three (33.3%) had unilateral disease. Most (13) of the cases belonged to 25 – 35 years age group and the only case of the carcinoma was aged 58years. Medical treatment with danazole or tamoxifen or both could not cause complete regression of the gynaecomastia but they provided partial regression and symptomatic relief. Another problem experienced by most of the patients was the inability to sustain the financial burden of maintenance of this medical treatment. In view of the above reasons, subcutaneous mastectomy was the treatment of choice for 8(57.1%) for cosmetic reasons. CONCLUSION: Gynaecomastia is the most common benign condition that affects the male breast and the aetiology in most cases is unknown. Although the psychosocial and cosmetic effects are of concern, particularly among the adolescents, a thoughtful approach to the patient presenting with this condition can lead to improved outcomes and patient satisfaction.