Teenage Gynecomastia Reduction

Q: Dr. Eppley, I am interested in teenage gynecomastia reduction. My 14 year old son has gynecomastia and is very embarrassed about it to the point he doesn’t take of his shirt in public to swim and he wears a tight shirt under his t shirts to hide it. I was not sure if you would perform surgery on him since he is still going through puberty or if insurance would even cover the procedure? Thank you

A: Thank you for sending pictures of your son’s chest. This appears to be a ‘soft’ type of gynecomastia which should respond well to liposuction reduction. His skin and areola will shrink back down with the fibrofatty breast tissue removal.

When it comes to his age, the ‘standard’ thinking it is that this type pf gynecomastia will go away on its own and that he is too young to have surgery. In my experience I find that thinking of early juvenile gynecomastia completely flawed. It will not go away on its own and he is at a critical psychosocial point of development. I would choose to have it treated and reduced now so he can feel a lot better about his chest appearance. Whether it will regrow in the future is unknown but, even if it does, there will still be self-image benefits to having the surgery now.

As for insurance coverage, they would require a complete endocrinological workup to prove there is not a hormonal basis for his gynecomastia (and there is a 99.9% chance there is not) and the gynecomastia would have to be much bigger than his. They would view his problem as cosmetic and deny coverage for it.

Dr. Barry Eppley
Indianapolis, Indiana