Adolescent Gynecomastia Q & A
Important notes about Gynecomastia & Adolescents
About 60% of adolescent men will develop gynecomastia to varying degrees. This adolescent form can be caused by some combination of hormonal influences, congenital syndromes, or obesity. Among all adolescents that develop this condition, in time at least half will see their cases subside or disappear completely. There are a few major questions:
- Will the gynecomastia disappear naturally?
- Is treatment for social and psychological effects of gynecomastia necessary?
- What treatment options are available, surgical or otherwise?
- What kinds of results can be expected from adolescent male breast reduction?
- At what age range is the treatment of adolescent gynecomastia appropriate?
When I began performing these procedures on adolescents over twenty years ago, I was as confused as the literature. There was virtually no research on adolescent male breasts, and few surgeons had extensive experience with male breast reduction surgery. Now after 25 years and significant numbers of adolescent patients, I have developed a keen sense of when adolescent requires early surgical intervention.
Very mild conditions may disappear at the beginning of adulthood. This kind of gynecomastia, mainly concentrated behind the nipple areola complex and sometimes known as puffy nipples, has the appearance of slight puffiness of the nipple. In these cases, in the absence of hormonal imbalances, endocrine disorders, and a family history of this condition, surgical treatment is generally not required.
In some cases, obese children develop the appearance of large breasts but without developing significant amounts of glandular tissue. This is referred to as pseudo-gynecomastia. It is marked by the diffuse fatty tissue infiltration of the breast & axillary (armpit) areas. In these cases, diet and exercise are necessary before considering surgical procedures.
In some cases, adolescent enlarged breast may not be a transient phenomenon. In these cases the adolescent male develops larger-than-normal deposits of glandular and adipose tissue that may be permanent. In my extensive experience working with adolescent candidates for male breast reduction, those who suffer from very large localized or diffuse forms, tubular shape breasts, saggy breasts with excess skin, or the presence of a strong family history of large male breasts may have a permanent condition. It is in these cases that surgery may be considered. This determination should be made by a plastic surgeon experienced in treating adolescent gynecomastia, in consultation with the patient, his parents, psychologists, endocrinologists, pediatricians, and sometimes with the patient's educators.
The teenage period are a child's important formative years. Psychological and social factors of this period may have implications for the rest on one's life. These are times of change for the individual, and they can be very trying.
Today, more than ever in recent history, body shape, image, proportions, and gender identity (masculinity and femininity) are of paramount importance to these young adults. Feelings of inadequacy in daily activities can have negative effects on an individual emotional state and view of the future. Especially at this age, nobody wants to be different and most want to imitate the fit role models they see before them in in movies, magazines, and sports.
When confronting adolescent patients, conservative measures should be attempted prior to the consideration of surgical intervention. In cases of possible pseudo-gynecomastia, patients should be sure to follow proper diet and exercise regimens before considering surgery. Similarly, in cases of possible hormonal imbalance, patients should consult with an endocrinologist. If young men with enlarged breast suffer negative psychological implications (depression, severe social problems, extreme academic problems, and others), they should consider seeing a psychologist for treatment of their emotional and mental difficulties until either surgery is performed or the gynecomastia disappears naturally. Should these conservative measures fail to remedy the patient's problems, surgical intervention should be considered as a last resort.
In treating adolescent gynecomastia victims, it is important to approach the problem as a team, including parents, teachers, and physicians such as pediatricians, endocrinologists and plastic surgeons. Of course the most important member of the team is the victim himself.
Each patient is unique. The results of male breast reduction vary from each individual to the next. The severity of the condition plays an important roll. The expectations of the patient, his parents and their psychological state of mind may influence their perception of the results. To help calibrate the expectation of the victim and his family, the plastic surgeon must discuss most minute details of the procedure, its risks, and its expected outcomes with the family. Visualization is another important tool in forming expectations. A plastic surgeon should be able to share with the patient and his family multiple before-and-after photographs of similar cases.
Although most cases can be treated with a periareolar one-inch incision, which usually heals with unnoticeable scars, some extremely severe cases (a minority of all cases) may require more extensive breast reduction surgery. In remedying these extremely large male breasts, scars may be more conspicuous than they would be otherwise. In these cases, the cosmetic benefits of removal of the glandular tissue may outweigh any resulting blemish.
A patient's age is important. Psychological and social aspects of youth must be considered. If possible, surgery should be deferred to age 17 and older. If for any of the above reasons surgery is considered at a very early age such as 13-16, careful consultations with the patient, family, and various team members are essential. Personally, I require that the parents and many of the above professionals submit written reasons for their endorsement of surgical treatment. Ultimately, the choice to undergo surgery is between the patient, his family, and the expert plastic surgeon. When the procedure is performed correctly and for the right reasons, the surgical outcome can be rewarding and long lasting.
Our young patients derive not only from New York, New York city (Manhattan), Brooklyn, Queens, Bronx, Staten Island, Westchester, Long island Upstate New York, but also from Connecticut, New Jersey but from many other states and countries.