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A patient, 18 years old, presents with breast pain and enlargement. There is no history of trauma, alcoholism, smoking, or medication use. A bilateral mammogram, bilateral ultrasound, and magnification view of the right breast are provided. What is the diagnosis? What is the cause of the appearance in the magnification view?

This is a male patient. The absence of breast parenchyma on the mammogram with an excess amount of fat represents “pseudogynecomastia”. There are multiple, tiny radiopaque densities with diffuse distribution. This is an artifact from “Talcum Powder”. One should clean the skin properly and repeat the radiograph in this case.

What is pseudogynecomastia?

Pseudogynecomastia, also known as lipomastia or adipomastia, is a condition characterized by the enlargement of male breast tissue due to an accumulation of fat, rather than the growth of actual breast gland tissue, which is the case in true gynecomastia. This condition is often associated with being overweight or obese and can affect men of all ages.

Causes of Pseudogynecomastia

The primary cause of pseudogynecomastia is an increase in body fat. Factors that contribute to this condition include:

  • Obesity: Excess caloric intake and lack of physical activity lead to fat accumulation throughout the body, including the chest area.
  • Hormonal Imbalance: While not directly caused, hormonal changes can influence body fat distribution.
  • Age: As men age, metabolism slows down, making it easier to gain weight.
  • Certain Medications: Some medications may cause weight gain as a side effect, contributing to the development of pseudogynecomastia.
 

Symptoms and Diagnosis

Pseudogynecomastia is primarily identified by the following symptoms:

  • Enlarged breasts due to fatty deposits.
  • Soft and compressible chest tissue.
  • Absence of a firm glandular tissue that is present in true gynecomastia.
 

Diagnosis typically involves a physical examination by a healthcare provider. In some cases, additional tests such as ultrasounds or mammograms may be used to distinguish between pseudo and true gynecomastia.

Treatment Options

Treating pseudogynecomastia focuses on reducing overall body fat through lifestyle changes and medical interventions:

  • Weight Loss: Adopting a healthy diet and engaging in regular physical activity can significantly reduce body fat.
  • Exercise: Strength training exercises that target the chest muscles can help tone the area and reduce the appearance of enlarged breasts.
  • Medical Treatments: In cases where lifestyle changes are insufficient, medical treatments such as liposuction or non-surgical fat reduction techniques may be considered.
 

Prevention

Preventing pseudogynecomastia involves maintaining a healthy weight through balanced nutrition and regular exercise. Avoiding excessive alcohol consumption and consulting with a healthcare provider about the side effects of any medications can also help in prevention.

Living with Pseudogynecomastia

Living with pseudogynecomastia can be challenging due to the potential impact on self-esteem and body image. It’s important to seek support from healthcare professionals, support groups, and loved ones. Remember, you’re not alone, and effective treatments are available to help you manage this condition.

Conclusion

Pseudogynecomastia is a common condition that results from excess fat accumulation in the chest area. Understanding its causes, symptoms, and treatment options can empower those affected to take control of their health and well-being. If you suspect you have pseudogynecomastia, consult with a healthcare provider to determine the best course of action for your individual needs.

Here is one of the nice articles on Imaging in gynecomastia: Billa E, Kanakis GA, Goulis DG. Imaging in gynecomastia. Andrology. 2021 Sep;9(5):1444-1456. doi: 10.1111/andr.13051. Epub 2021 Jun 10. PMID: 34033252.

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