INVESTIGATION OF CLINICAL TYPES, HORMONAL PROFILE AND TREATMENT OUTCOMES IN PATIENTS WITH GYNECOMASTIA

Gynecomastia is a common condition such that nearly 40% all boys develop this condition during puberty and 36% of men aged 17-58 years have palpable breast tissue. Nearly two-thirds of patients have been reported in western literature to respond to tamoxifen therapy. In the rest, surgical management in pursued in the form of subcutaneuos mastectomy with good surgical results. There have been multiple case reports on gynecomastia from Indian sub-continent but not a single large series has yet been published. Here at AIIMS outpatient department, we come across a large number of patients with gynecomastia and operate on thirty to forty cases each year. Thus a dedicated reserch with an aim to document the clinical types, hormonal profile and treatment outcomes of gynecomastia will add up significantly to the existing literature.

 In our study, patients with gynecomastia will be recruited from surgical or endocrinology OPD. Patients will be evaluated with clinical examination and pertinent investigations including ultrasound and biopsy. Patients will be prescribed 20 mg/day of tamoxifen for three to six months unless they have any contraindication to tamoxifen. Patients will be reassessed after three months of tamoxifen therapy to check the response. If there is significant reduction in breast volume (> 50% reduction) at three months, then tamoxifen will be continued for further 3 months. Patients with minimal or no response will be randomized to undergo either a one stage or 50-50 two stage subcutaneous mastectomy (half of the breast plate excised by circumareolar incision and repeat excision of remaining half 3 months later). Patients will be followed up in clinic for final surgical outcome assessment at 6 months.