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Gynecomastia is the abnormal enlargement of one or both breasts in a male. It is actually a common condition that occurs in one-third to two-thirds of boys between the ages of 10 and 16 years old. Fortunately, in most cases, the condition resolves without any treatment and in only about 8% of cases does it continue beyond the teenage years. In those boys who have continued and significant gynecomastia, problems with self-esteem and body image may emerge.

A recent study examined the psychological changes in a group of boys with ongoing gynecomastia and found that all of them had at least one psychiatric diagnosis, most commonly an adjustment disorder (an emotional and behavioral reaction that develops within 3 months of a life stress, and which is stronger or greater than what would be expected for the type of event that occurred). Other findings included anxiety, depression and social phobia. In some cases, the boys went to extreme measures to hide their breasts. The authors of the study reported that:

“Most (of the boys) noted a decrease in self-confidence and, for many, a negative self-image. All of the patients indicated that they restricted activities, including sports, social events with peers, and family outings, because of concern that others would notice or comment on their breasts. As a result, many of the patients had limited contact with peers, particularly in the summer when their breasts were likely to be more apparent under lighter clothing. None of the patients were comfortable with swimming either at school or during the summer, and one patient failed his gym class because he was not willing to swim without a shirt. Another patient stated that he would not return to school because of the teasing he suffered.”

While many boys with gynecomastia are able to tolerate and eventually outgrow it, for some the problem is much more sever and can disrupt normal activities and behaviors. In such cases, pediatricians frequently refer these boys to plastic surgeons for treatment. The procedures available include removing the excess breast tissue, liposuction to reshape the chest and sometimes removal of extra breast skin.

“Gynecomastia is a challenging problem for many boys and their parents. In addition to the obvious breast tissue, some boys experience significant physical pain and discomfort from the hard breast mass that can be seen with gynecomastia. The pain may interfere with sports and other normal activities. Since most insurance  plans do not pay for gynecomastia treatment, parents may become stressed if their son doesn’t outgrow this condition. While there aren’t any nonsurgical treatments (pills, injections or therapy) for boys with ongoing gynecomastia, in my experience surgery offers excellent results and a prompt improvements in these boys self-esteem. These are among the happiest patients in my practice.”

Karol A. Gutowski, M.D.

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