Niewoehner and Schorer do not mention the long list of drugs which can be associated with gynaecomastia, especially in elderly patients.1 A list (produced by the pharmacy of the Norfolk and Norwich University Hospital in 1993) has 69 drugs on it, including the commonly prescribed drugs allopurinol, amitriptyline, atenolol, ciprofloxacin, chlorpromazine, digoxin, enalapril, furosemide (frusemide), nifedipine, verapamil, and warfarin (the list is far too long to be included in a letter). In clinical practice, medication is the commonest cause of gynaecomastia in elderly patients.
One important point relating to surgical technique when removing excess breast tissue in young men should also be mentioned: excising all the abnormal breast tissue will result in an unsatisfactory cosmetic outcome as the enlarged breast will be replaced by a dent. A sufficient slice of breast tissue should be left to prevent this happening, and I have never encountered recurrent gynaecomastia despite adopting this technique over many years.
Competing interests: None declared.
References
- 1.Niewoehner CB, Schorer AE. Gynaecomastia and breast cancer in men. BMJ 2008;336:709-13. (29 March.) [DOI] [PMC free article] [PubMed] [Google Scholar]