Can surgery prevent recurrence?

[dlundgren]

I've always had what I felt might be a bit of gynecomastia following puberty.  It was fairly minor, though, and not really noticeable to most.  Recently, though, I had to take Prilosec for gastric reflux disease.  That, perhaps coupled with Propecia, gave me really bad gynecomastia, especially on my left side. 

What I'm wondering is this -- if I have normal/typical surgery for this condition, can it be performed such that all glandular tissue is removed, or such that recurrence otherwise is highly unlikely, even if I have to go back on Prilosec and stay on it chronically?  I'm 34 years old.

I ask for this reason -- it's looking very unlikely that I'll be able to go off of Prilosec (I've been off for a few weeks and gastric reflux has returned severely), and I don't want to stop Propecia and have my hair fall out.

Thanks for any responses.

[Litlriki]

The relationship of gynecomastia and prilosec (omeprazole) is weak or non-existent.  Cimetidine is the only GERD medication that has a strong association with gynecomastia unless some new information has come along recently. 

That said, the procedure to correct gynecomastia always leaves behind a small amount of tissue (gland) under the nipple-areola, and that tissue could grow again with stimulation, though I wouldn't think Prilosec should be a problem.  If you're using Propecia, that is much more likely to be the cause.  I'm not sure if there's any mechanism whereby the combination of Propecia and Prilosec compounds the effect of the Propecia, but if you're just using the GERD medication, I don't think recurrence would be likely.  If you're committed to hair, then you might be prone to recurrence even after a full resection.  In that case, you may need to decide between hair and gynecomastia.  Perhaps one of the other surgeons has experience with patients who have had correction and resume Propecia treatment.  I have patients who have had their surgery and are on Propecia, but the gynecomastia wasn't caused by the Propecia in the first place, and they've been fine afterwards.

Rick Silverman

[Dr. Elliot Jacobs]

Recurrence after proper gyne surgery is rare.  However, Propecia, which is commonly used, bears a special discussion.

I have had two groups of men.  Those in whom gyne developed prior to their use of Propecia and whose gyne did not change while on Propecioa.  For these men, gyne surgery seems to be OK and their gyne did not recur even if they resumed Propecia after surgery.

On the other hand, there are some men who developed gyne after starting Propecia or whose gyne worsened after they took Propecia.  These guys may be prone to stimulation of gyne growth from use of Propecia and I would be hesitant to recommend it after gyne surgery for fear of recurrence.

Merck, which is the manufacturer of Propecia, is not anxious to explore this side effect of Propecia because it could interfere with their sale of the drug.  Thus, do not expect any medical studies.

Unfortunately, gyne is a side effect of use of Propecia -- but only for a small percentage of men.  There is no way to test to see if someone is prone to develop gyne after starting Propecia -- the only way to know is after the gyne as developed -- and then it is usually too late -- surgery is needed to remove the gyne.

Dr Jacobs

[dlundgren]

Very interesting; many thanks to you both for your replies.  For what it's worth, I had been on Propecia for about 6 years with very minor gynecomastia, if any, at least relative to what I have now.  Once I went on Prilosec (while also on Propecia), I felt potential gyne growing a couple days in, and within a few weeks, had a mass about 2/3 the size of a golf ball (but not perfectly round -- flatter, like if you took a ball of Play-Doh and pushed it down slightly) under my left nipple.

Just an anecdote that may be of value to you or others.

[DrPensler]

Propecia is known to cause gynecomastia in a small number of cases, however  the exact mechanism of action has not been clarified. Repeated use of any agent that causes gynecomastia after surgery may result in recurrence in that all of the glandular tissue is not removed at surgery. To remove 100% of the glandular tissue the nipple would need to be removed. Your history suggests a synergistic effect from the Prilosec which I have never heard exists. I have some contacts at the company who may be able to shed some light on a potential connection between the two drugs if one is known. If there is any information regarding a correlation I will let you know.