Most boys enter puberty between the ages of 11 through 14. At this time, there is a huge increase in the natural production of testosterone and, to a much lesser degree, estrogen. Although the exact mechanisms of the development of gynecomastia (male breast enlargement) are unknown, certain hormones play a great part. It is not known whether excessive estrogens are produced, whether there is an imbalance of estrogen and testosterone or whether the small amount of innate breast tissue that is naturally present in every male is just extraordinarily sensitive to the small amount of circulating estrogen. Certainly, there are hereditary factors at play as well. Whatever the cause, the result is gradual, occasionally painful and tender, enlargement of the breasts (or rarely, just one breast). Oftentimes there will be subsidence of this tissue, but in many cases, the problem will be permanent. It is estimated that more than one-third of the male population has some degree of gynecomastia – much of it carried from puberty into adulthood. One of Dr. Jacobs’ most interesting cases was that of an adolescent boy who developed gynecomastia. His father, a pediatric endocrinologist who was very familiar with gynecomastia, did sequential blood tests for hormones on his son just as the breasts were developing. Interestingly, there was never a major hormonal imbalance noted between testosterone and estrogen. What was the cause of his son’s gynecomastia? He didn’t know.
In our New York adolescent gynecomastia patients, the condition can vary from a small nubbin of very firm breast tissue beneath the areola to a large, female-like, pendulous, double D cup breast. It can occur in slender individuals and is unmistakable in appearance. But it can also occur in individuals who are overweight, in which case the fat and breast tissue are interspersed together in a condition known as adipo-gynecomastia. Sometimes it can exist merely as “puffy nipples.”
HOW DO ADOLESCENTS REACT TO GYNECOMASTIA?
No matter what the case, this benign condition has a profound effect on the psycho-social development of an adolescent boy. Often there is a shame, embarrassment, ridicule, bullying and sarcastic remarks from others so that an individual becomes reclusive and reluctant to participate in sports or to go shirtless at the gym or in public at a beach or pool. Children have been known to grab and twist the breasts of gynecomastia victims. Some boys will deliberately become obese because it is more socially acceptable in our country to be obese than to have enlarged breasts.
They will walk hunched over or may wear three layers of shirts. Others actually tape their chest flat!! Self-esteem becomes a significant problem and they often become shy and reclusive. They avoid intimate situations and are reluctant to socialize with girls. Their emotional turmoil can result in poor grades at school. Boys are reluctant to confide in their parents and will become shy about their problem. They suffer in silence. Indeed, this condition can be psychologically crippling! They do not know what has happened to their body and they don’t know where to turn for help. Why put a young man through this?
HOW DO PARENTS REACT TO THEIR ADOLESCENT SON?
Attentive parents will notice that their son is changing as he goes through puberty. Certainly, this is a tough time for young boys – their bodies are changing, their hormones raging and their emotions are in constant flux. Virtually all boys have some amount of these changes. But parents should also be aware of some differences. A young man walking hunched over, wearing three layers of clothes even in hot weather, never swimming topless, becoming reclusive – all are hints that something else may be going on.
If your son approaches you about his chest, do not brush him off – try to be empathetic to his situation. And if he does not say anything to you, then instead of waiting for him to approach you, you should reach out and discuss the situation with him. Tell your son that you are there for him and that he can count on your support. Gynecomastia cannot be cured by diet and exercise – don’t brush off your son and tell him to just work out (PS he has probably already done so). Gynecomastia can be a very lonely condition to live with. Why not provide the opportunity for your son to open up to you and make his loneliness a thing of the past?
HOW DO DOCTORS REACT TO ADOLESCENT GYNECOMASTIA?
Unfortunately, in American medicine, certain myths are repeated so often that they become accepted rhetoric. Treatment of adolescent gynecomastia is one of these myths. Many pediatricians are familiar with this condition, but unfortunately and all too often, they will reassuringly pat the boy on the shoulder and tell him to “wait it out – it will go away – just wait until you are 18 years old. But if gynecomastia has been present and stable for two or more years, it doesn’t disappear and in many cases, an adolescent boy will spend all his remaining teen years waiting in vain for his breasts to disappear. Those are indeed precious years when ego strength and self-confidence are developed and the presence of gynecomastia can be a severe detriment to the normal development of self-image and socialization skills.
Traditional teaching in both the pediatric and surgical fields has been to defer and delay treatment for fear that it might recur after surgery. I disagree. I have not had one recurrence in all my patients, including those as young as age 12!
I feel that gynecomastia in an adolescent is both a physical and psychological problem and that appropriate treatment can literally and physically “lift a weight off a boy’s chest.” Towards this end, I began to treat adolescent boys from age 12 to 18 with surgical removal of their excessive breast tissue. Age is not a strict criterion. Rather, the stability of the condition (ie the breasts are stable for at least two years and are not continuing to grow) and the general health and emotional maturity of the adolescent about to undergo a surgical procedure must be considered.
DESCRIPTION OF THE NEW YORK ADOLESCENT MALE BREAST REDUCTION PROCEDURE
Male breast reduction surgery is performed in our New York ambulatory operating room suite, which is a fully accredited (by The Joint Commission), hospital-type operating facility. The surgery takes 60-90 minutes under safe “twilight sleep” anesthesia (administered by a board-certified MD anesthesiologist). Thorough pre-operative testing is performed. (For a complete description of the operation, please see The Procedure elsewhere on this website). There is some soreness after surgery which is treated with appropriate analgesics. Most boys can return to school within 2-3 days after surgery and to active sports life within four weeks after the procedure.
WHAT CAN BE EXPECTED AFTER GYNECOMASTIA SURGERY IN NEW YORK?
An advantage of surgery on an adolescent is the excellent elasticity of the skin – even large breasts can be removed with a significant and rapid tightening of the skin. Young males are healthy and heal quite rapidly as well. Most gratifying is the rapid change in posture and overall attitude that occurs within a few days after surgery. These boys have more self-confidence. They often sport a huge grin as they return for a follow-up examination, standing up straight and frequently wearing a snug T-shirt for the first time in years. Oftentimes, with their embarrassment now gone, they will hit the gym and in time have an excellent muscular physique.
To date, I have successfully operated upon hundreds of adolescent boys and not one boy has had a recurrence of his gynecomastia. In sum, I believe this is a safe and appropriate treatment for adolescent boys.