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 development of gynecomastia (male breast enlargement) are unknown, certainly hormones play a great part. It is not known whether excessive estrogens are produced 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. Whatever the cause, the result is gradual, occasionally painful and tender, enlargement of the breasts (or rarely, just one breast). Oftentimes there will be a subsidence of this tissue, but in many cases the problem will be permanent. It is estimated that approximately one third of the male population has some degree of gynecomastia - much of it carried from puberty into adulthood.

Gynecomastia can vary from a small nubbin of very firm breast tissue beneath the areola (like a stack of quarters) 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. No matter what the case, this benign condition has a profound effect on the psycho-social development of an adolescent boy. Often there is embarrassment, ridicule and sarcastic remarks from others so that an individual becomes reclusive and reluctant to participate in sports or to go shirtless in public at a beach or pool. Some boys will deliberately become obese because it is more socially acceptable in our country to be obese than to have enlarged breasts. Boys will not confide in their parents and will become shy about their problem. They do not know what has happened to their body and they don't know where to turn for help.

Pediatricians are familiar with this condition, but unfortunately and all too often, they will pat the boy on the shoulder and tell him to "wait it out - it will go away." But it doesn't disappear in many cases, and an adolescent boy will spend all his precious 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 normal development of the sense of "self."

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 feel that this 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 have begun to treat adolescent boys with surgical removal of their excessive breast tissue. Age is not a strict criterion. Rather, the stability of the condition (ie the breasts are not continuing to grow) and the general health and emotional maturity of the adolescent about to undergo a surgical procedure must be considered.

The procedure is performed in a 60-90 minute ambulatory operation under "twilight sleep" anesthesia (administered by a board certified anesthesiologist). Thorough pre-operative testing is performed. There is some soreness after surgery which is treated with appropriate analgesics. Most boys can return to an active sports life within four weeks after the procedure. To date, I have operated upon over 25 adolescent boys (the longest follow-up is 7 years) 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.