What Is The Cause Of My Recurrent Gynecomastia Problem?
Q: Dr. Eppley. I am a 40 year old male with bilateral gynecomastia of undetermined origin dating back to puberty. I had surgery for it over 20 years ago which was not unsuccessful. By the surgeon’s baffled admission, it resulted in regrowth of breast tissue well beyond the original (pre-surgical), size. Since I had fully understood the procedure’s potential risks and could hardly blame the surgeon for the result, I dropped the issue altogether resigning myself to a lifetime of gynecomastia. However, having just come upon your site, particularly your discussion of the link between gynecomastia and temporal lobe epilepsy in King Tut's case, I cannot help wondering if a similar involvement has been a hidden factor in my own condition. Although I was never diagnosed with epilepsy, I had a fainting episode at 15 (coinciding with gynecomastia onset) followed by severe headaches, blind spells, and dysphoric moods. This was attributed by a neurologist to a “temporal lobe dysfunction due to damage to the sella turcica region of the brain,” possibly as a result of either meningitis or encephalitis. The antidepressants and anticonvulsants I have been prescribed to control what subsequently became recurrent major depression seem to implicate the condition further even as they themselves can either cause or aggravate gynecomastia as a side effect. I am wondering what your thoughts or suggestions might be in my perplexing case.
A: In regards to the cause of your gynecomastia, it is always an elusive question for most patients. Drugs are a common culprit although for most patients the exact reason is unclear. Whether there is any relationship between your neurological history and gynecomastia is speculative. I have never heard of regrowth of gynecomastia around a prior excision site and I would question that diagnosis anyway. I would wager it most likely represents inadequate resection that only become more evident after all the swelling went down months after the surgery. One of the hardest elements of open gynecomastia surgery through an areolar incision is getting adequate resection of the involved tissues well away from the areolar access area. A common aesthetic complication is to have adequate areolar resection but a surrounding donut of residual tissue that may not become evident until many months later when all the swelling has subsided and the skin has adequately contracted down, revealing the extent or lack thereof of the resection margins. This would suggest that further efforts at gynecomastia reduction may still be successful.
Dr. Barry Eppley