Gynecomastia is a deformity that usually manifests in teenage boys where there is massive hormone stimulation of the nascent breast tissue causing enlargement associated with pain and a very disturbing physical deformity. Gynecomastia tends to run in families therefor there is some genetic component and usually becomes manifest in the early teenage years when male hormones are active. It is usually associated with mild to moderate torso obesity. The deformity is worsened by weight as there usually an aspect of the deformity that is fat tissue in addition to tender breast tissue. It is that fat portion of the deformity that has caused insurance carriers to demand weight loss as well as hormonal studies to document and treat the disease. There are insurance carriers who specify in their contracts that they explicitly do not cover gynecomastia resection under any circumstance.
The treatment of gynecomastia in adolescents should include, if necessary, an attempt at weight loss followed by surgical resection, usually tumescent liposuction technology. Unfortunately, if surgery is performed in the early to mid-teenage years there is a possibility of recurrence, usually beneath the nipple/areolar complex, as it is virtually impossible to remove the breast tissue in its entirely. Additionally, any upper fluctuation in weight will also give the appearance of a recurrence.
Gynecomastia in adult males is usually due to excessive marijuana smoking and/or abuse of anabolic steroids or large doses of testosterone. Most men who fit this profile are body builders with a reasonable low body fat. Those with higher body fat percentages also have a fatty component to the deformity. Most body builders who “stack” their anabolics also take an anti-estrogen drug trying to prevent the painful breast enlargement. Surgical removal for pain relief and cosmetic chest improvement usually requires direct excision. These men usually have hypertrophic and highly vascular chests causing common hematoma formation post-operatively. Again, recurrence can be common if the patient continues to use steroids.
Gynecomastia, especially the teenage version, occurs at a very unsettled age when there may be extreme body dysmorphism. Children this age can be unpleasantly negative at a time when undressing for the gym or going to the swimming pool can be a traumatic event. These psychological issues are reason enough to operate early even if a re-do becomes necessary.
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