Bilateral Recurrence of Painful Dense Fibrous Gynaecomastia Seven Years Following Primary Excision of Steroid-induced Bilateral Gynaecomastia: A Case Report

Gynaecomastia is the proliferation of male breast tissue and is most often treated effectively with surgical excision of the glandular component. Late recurrence following a seemingly complete excision is unusual, particularly when the original disease was related to anabolic androgenic steroid exposure. We describe a healthy Caucasian male who had a history of anabolic steroid use more than a decade ago. He underwent bilateral excision of tender gynaecomastia seven years previously, with full symptomatic relief. He recently re-presented with new bilateral painful subareolar masses that extended laterally toward the chest wall. On exploration, firm, ‘banana shaped’ fibrous cords of glandular tissue were discovered, adherent to the serratus anterior muscle and the pectoral muscle. Histopathological analysis confirmed gynaecomastia with dense stromal fibrosis. Following meticulous surgical excision, the pain resolved, and the patient returned to normal activities. This rare presentation of late, bilateral, fibrous recurrence demonstrates that even after apparently complete excision, persistent microscopic glandular foci may evolve over time. Clinicians should be aware of the fibrous phase of gynaecomastia, particularly in men with a history of anabolic steroid exposure. Recurrent fibrotic disease in patients who present with new painful chest wall masses many years after primary surgery should be considered and consented to during the preoperative consultations.