Q: I am inquiring about breast surgery for my son who is 14. He has developed small breasts and is quite conscious of it. He will not go swimming or even take his shirt off during gym class. (so I am told by his brother) My family doctor said it is gynecomastia and that it goes away in most teenage boys. He said we should wait until he is 18 years old before considering surgery. Given that it bothers him so much, and has made him very shy and reclusive, I was wondering what your thoughts were. Can surgery be done sooner rather than waiting? I am just desperate to help him and make him feel better.
A: While gynecomastia, male breast enlargement, does go away in some teenage boys, many times it does not. The historic teaching is to wait until the teenage male is near full development. In analyzing that approach further, its intent is to not subject a teenager to unnecessary surgery. In the spirit of such waiting, however, the teenage boy may (likely) develop self-image issues and psychosocial issues.
Given the exposure to potential social pressures and ridicule, I not think that such waiting is worth the trade-off. Gynecomastia surgery can be repeated (although I have never seen that necessary) but the emotional damage can be very difficult to get past. Therefore, in my Indianapolis plastic surgery practice I am an advocate of surgically treating gynecomastia early (age 14 is an acceptable age) provided that it is significant enough and one is certain that there is not a hormonal reason for it. While a hormonal cause (endocrine tumor) is a very rare cause of gynecomastia, they do occur. If the gynecomastia involves both sides of the chest and is not subtle, I would recommend getting him seen by an endocrinologist first.
Many cases of teenage gynecomastia that I seen today are less significant than they used to be. This is undoubtably a reflection of the changing cultural standards from decades ago.
Dr. Barry Eppley