Pathology belongs to the category of those for which any subjective sensations and discomfort do not arise, but the required dynamic monitoring and correction of the state – men is quite sensitive to the loss of external masculine (male) attributes.
The elimination of this violation is often quite simple actions – reduce caloric intake and increase physical activity. With considerable severity of fat accumulation requires the appointment of drugs that accelerate the metabolism and reduce the absorption of fat particles in the intestine. In extreme cases, resort to surgical removal of excess fat.
Among all the disorders of fat metabolism lipomastia is fairly common of their kind. The condition is considered to be a pathology, but a threat to health and life men the isT. on the other hand, at the very impressionable and emotionally unstable men lipomastia can often lead to psychological problems. They can be quite dangerous, as men are very much affected about their unmanly, “ionoobmennogo” type, at the same time ashamed to take his problem to the discussion even in a narrow circle of health professionals – formed a vicious circle, the patient alone can not cope with the problem. Even recorded suicide attempts by some of these patients.
Deposition of fat in the Breasts can occur in men of different ages, from 14-year-olds to seniors and even the elderly. Lipomastia can be:
In the first case, the pathology is diagnosed in age from 20 to 50 years. In the second case, most often affects boys who have started puberty, and the elderly, in the body where there is a total involution (reverse the development of organs and tissues).
To diagnosis lipomastia should be treated very carefully the disease could indicate serious somatic and endocrine disorders, which became the impetus for the development of described pathology. Therefore, when any, even insignificant increase in breast glands men should seek help from a specialist. The primary appeal may be to the therapist’s place of residence, and he will direct the patient to a specialist.
Pathology has other names – is false (or fat) gynecomastia (the term means the formation and development of the breast the type of breast in women), pseudogynecomastia.
The main defining reason for lipomastia is often common obesity – excess deposition of fat simultaneously in many parts of man’s body (often the abdomen or thighs). Pretty rare pathology observed in men with normal weight, even less with reduced.
Also highlighted contributing factors that directly to the development of lipomastia not cause, but contribute to its emergence and progression. In the first place is:
- genetic predisposition;
- regular intake of large amounts of calories. It can be absorbed as a high calorie food, and low in calories, but in large quantity. Occurs in prone to overeating men;
- the abuse of alcoholic beverages;
- psychological problems, resulting in their “binding”;
- hormonal disturbances.
Lipomastia often develops in men with the so-called constitutional-exogenous obesity – the so-called deposition of excess fat in a combination of three factors:
- balanced, abundant diet;
- hypokinesia – reduced locomotor activity;
- hereditary predisposition to obesity.
At the same time these men are diagnosed genetically determined deficiency of leptin – one of the key hormones that regulate:
- the feeling of hunger;
- energy metabolism in the body.
Moreover, these patients often marked by insensitivity to the action of leptin. The end result is the body loses the ability to fight excessive fat deposits.
High-calorie diet plays a key role in the emergence of lipomastia. Excess calories that enter the body with food, is accumulated (stored) by the body in fat depots is one such depot become the breast. However, note that the increase in energy intake is of two types:
- absolute – it occurs when the consumption of large quantities of high-calorie foods;
- relative – it leads to reduced motor activity.
In turn, to reduced physical activity can result in the following reasons:
- forced bed rest due to injuries, serious illnesses, extensive operations, critical States (coma);
- the specifics of job – reduced motor activity observed in programmers, writers, copywriters, technicians, and so on;
- chronic fatigue resulting from excessive loads at work and at home – most commonly psychological (physical type of work in any case to obesity and occurs on the background of lipomastia does not);
- banal everyday laziness, against which a man deliberately restricts itself to physical activity.
Alcohol abuse is a “silent enemy” that can lead to the development of the described disease. By itself, the alcohol from the point of view of nutrition – specific product is: it has very low nutritional value but high calorie. Alcohol use and abuse causes a disruption of recycling (processing) of estrogens in the liver and accumulation of fat deposits in “feminine” type. This situation is even more pronounced in patients who abuse beer – it contains phytoestrogens. Alcohol increases appetite – drinking, more eating. All these factors would lead to the fact that the man consumes a large amount of food, and as a result appear body fat – including in the Breasts.
Psychological problems – one of the factors contributing to the emergence of lipomastia. Men less often than women, tend to “seize” the troubles of life – however, some patients with lipomastia on reception at the expert admitted that in various household, social and production problems, tried to escape and enhance your mood with absorption of a large amount of delicious food. The situation is exacerbated by the intake of alcoholic beverages.
To the emergence of lipomastia can lead to hormonal disorders, which provoke the failure of fat metabolism. This occurs when:
- the number of somatic pathologies;
- the use of hormones.
In the first case, most often this disease:
- adrenal glands;
- of the thyroid gland.
In the second case lipomastia often occurs when taking corticosteroids – prolonged and/or uncontrolled.
When hormonal imbalance is disrupted basal metabolism, and this contributes to deposition of deposits of excess fat particularly in the Breasts.
The development of the pathology
It is believed that a key link in the development of lipomastia is an increase in both the number and volume of fat cells. An additional precipitating factor is the relative increase in estrogen levels. It can occur in men due to the action of the aromatase – specific enzyme is located in adipose tissue and performs the role of a “supervisor” on the transformation of the male sex hormone testosterone into the female sex hormone estrogen. The concentration of female sex hormones increases, which inevitably leads to a specific distribution of fat on the so-called method (female) type – it mainly accumulates in the hips, buttocks, and breast. Therefore, men with lipomastia almost always at the same time complain of the increase in volume of the thighs and buttocks.
In some patients lipomastia develops simultaneously with gynecomastia. Such violations often occur when an imbalance of sex hormones, which occurs in:
- teenage boys puberty;
- patients older than 50 years during the period of the extinction of the endocrine function of the testes.
Increase the amount of estrogens in these patients leads to the growth of not only fat, but also glandular tissue of the breast.
Complaints from patients are received only on the occurrence of violations of aesthetic nature – in other words, enlarged Breasts and the transformation of its forms of the female type. While men are concerned not only increase and deformation of the breast – they wonder if they have developed any critical endocrine or oncological disorders. Often, the emotional men the clinical symptoms of the breast does not correspond to the severity of anxiety – panic even insignificant increase of the breast. Therefore, doctors who treat such patients, prepared for the fact that if lipomastia may be too severe psychogenic composite clinical picture, such men can be emotionally excited or expressing extreme concern for his condition, or closed, silent, lost mentally with the problem.
Some men ulterior lipomastia can “get lost” against the background of the General structure of the body because of its constitutional features. Talking about hypersthenic Constitution (body type) – these men are the following symptoms:
- more pronounced lateral dimensions of the body;
- thicker and heavier bones;
- short legs and wide hips;
- a broad chest.
Due to the last factor, and can be undetected by lipomastia.
In most clinical cases as such unpleasant subjective sensations in the onset and progression of lipomastia in men – pain and discomfort are absent. Rarely, they may arise when attaching a secondary symptoms:
- inflammation of the penetration in the tissue of the breast with blood or lymph of pathogens;
- education on the background of overall body fat local thick accumulations of adipose tissue that may press on nerve endings and thus cause discomfort and in some cases pain.
Diagnosis of lipomastia is not complicated, but the pathology must be clearly distinguished from gynecomastia, as to what will be the diagnosis depends on a fundamental approach to treatment.
Therefore, the diagnosis of the described diseases are important are:
- patient complaints – even if they are emotionally charged (for the unstable emotional and mental condition can be suspected other pathology – in particular, the primary exchange due to violations of the thyroid gland);
- the details of the anamnesis (history of disease and life) is a tendency to overeating, lack of adequate physical activity;
- the results of additional methods of examination – physical, instrumental, laboratory.
The results of the physical examination the following:
- at the General survey – in most cases revealed signs of General obesity. This increase in total weight, the deformation of the contours of the body, fat in different zones of the male body;
- the local examination – an increase various degrees of the breast. It can be as insignificant, often localized in the nipple, and a pronounced, noticeable even before the patient took off his clothes for inspection in the office of the doctor. If lipomastia expressed, then the nipple-areola complex is often displaced downward;
- palpation (feeling) – the breast is soft, in most cases painless their tissue structure is homogeneous, without seals. When pressed discharge from the nipple do not exist.
In most cases, lipomastia is bilateral and symmetrical.
The task of the doctor is not only the identification of fatty tissue in the Breasts of the patient, but also the establishment of the causes of lipomastia. Therefore, in some cases, a set of diagnostic procedures can be quite extensive. For better diagnostics it is recommended that first consultation of narrow specialists gastroenterologist, endocrinologist, andrologist, oncologist, neurologist, psychologist and psychotherapist. They will help to narrow the range of necessary additional diagnostic methods.
Instrumental methods of examination usually, the diagnosis of this pathologyare applied:
- ultrasound breast (ultrasound) – their fabrics are characterized by low echogenicity, focal changes are not observed, the regional lymph nodes are not changed. Ultrasound of the breast in these patients is carried out in dynamics – on a regular basis to track changes that might indicate progression or regression of a pathology, which became the immediate cause of lipomastia;
- ultrasound examination of the internal glands – primarily the pancreas and adrenal glands. It will help to establish the cause of lipomastia;
- mammography – comprehensive breast examination. It is often in cases of suspected breast cancer;
- biopsy – sampling of tissue fragments of the breast with subsequent study under a microscope.
Laboratory methods used in the diagnosis of this pathology is:
- General analysis of blood – it is not a specific research method, but a sharp increase in ESR may indicate oncological nature of the lesion of the same pancreas or adrenal glands, which could lead to the development of lipomastia;
- determination of level of sex hormones – if lipomastia the content of free and bound testosterone and estradiol in most cases is not increased, but the number of patients detected relative hyperestrogenia – increasing amounts of estrogen;
- liver function tests – they are carried out to study the factors contributing to the development of lipomastia. While analyzing the number of bilirubin and its fractions, ALT, AST and so on. They assess the amount of liver failures which can lead to impaired fat metabolism and indirectly provoking the development of lipomastia;
- histological examination under the microscope studying the structure of tissue biopsy;
- cytological examination under a microscope, studying the cellular structure of biopsy.
Differential diagnosis of
Differential (distinctive) diagnosis of lipomastia often carried out:
- with a significant increase in breast cancer with gynecomastia;
- in local manifestations of pathology – diseases of oncological nature.
In the latter case, it may be a tumor:
- benign – lipoma (from fat tissue), fibroma (connective tissue), angioma (blood vessels) and so on;
- malignant – liposarcoma, fibrosarcoma and others.
Complications directly from the breast, enlarged and “crowded” fatty deposits, is quite infrequent. It can be:
- fat necrosis – necrosis of adipose tissue, with subsequent disintegration, which is often observed in traumatic compression of the altered breast;
- inflammatory lesions of the breast – can occur when the penetration of pathogenic microflora lymphogenic (lymph flow), hematogenous (through the blood) ways, and also at infringement of integrity of the skin.
More common complications of the neuro-psychic sphere. Increase breast provokes their resemblance to the mammary glands in women, leading to the shame of men, reduced his self-esteem, insecurity in dealing with the opposite sex. In the worst cases can arise:
- neurotic reactions in the form of anorexia – refusal of food and the desire to lose weight by any means;
- dysmorphic disorder – excessive concern and even hatred in relation to breast enlarged and deformed glands;
- depression until the appearance of suicidal thoughts;
- hypochondria – sadness with possible bouts of obsessive irritability, frustration;
- the kantserofobiey – morbid obsessive fear of Contracting malignant diseases of the breast.
The described condition leads to a significant deterioration in the quality of life of men.
Treatment of lipomastia men
Treatment of lipomastia can be:
- conservative – main;
- operational – according to indications and the patient’s wishes.
To have tangible results, this method of treatment often requires long time and patience – but it is an effective and essentially the most safe in comparison with taking drugs and involving the surgical treatment. Despite the seeming simplicity of the method, self-treatment is prohibited for these patients will require the appointment of a nutritionist and physical therapist (physical therapy).
If the increase and deformation of the breast against the background of lipomastia significant, moreover, there was a strong psychological discomfort, apply:
- correctors of metabolism;
- surgical methods of treatment.
Of correctors of metabolism is effective in lipomastia are tools that:
- increase the basal metabolic rate;
- reduce the absorption of fat.
Surgical methods used liposuction (liposuction):
Liposuction is performed in uncomplicated cases of lipomastia – to remove soft fat in the absence of gross connective tissue partitions. In other cases, liposuction is performed in combination with mastopexy – surgical tightening of the skin of the breast.
Often perform concurrent liposuction – removes excess fat not only in the Breasts, but in the other locations.
The most effective interventions prevent the development of lipomastia are those that prevent the development of common obesity. This:
- balanced diet – limit the intake of fatty foods and sweets, drinking sufficient amounts of vegetables and fruits, limit intake, and even better a complete rejection of alcoholic beverages;
- regular physical activity;
- prevention of diseases, which can contribute to obesity, and when they occur timely treatment.
The prognosis of lipomastia generally favorable. With proper treatment, unwanted body fat disappear. If the excess fat was removed surgically, then with continued exposure to provoking factors, the possible recurrence of the disease.
Kovtonyuk O. V., medical columnist, surgeon, consultant physician