Gynecomastia is the enlargement of a male's breasts secondary to various factors. It occurs in adolescence because of temporary hormonal imbalance of testosterone (male hormone) and estrogen (female hormone). It affects 30 percent - 60 percent of all males reaching puberty, and subsides by age 18 in 80 percent of the cases. Medically, usually a benign temporary condition, psychologically, a whole different story!
Teenagers and young men with gynecomastia often endure significant teasing and embarrassment. Due to the emasculating nature of this condition, many of those afflicted find it difficult to discuss. Unrelenting criticism and taunting by peers may cause development of serious body-image issues such as avoidance of exposing the body (especially at the beach or locker room), withdrawal from peers and depression. A complete understanding of the condition will assist in dealing with the issue.
Gynecomastia is characterized by some or all of the following:
• Excess localized fat
• Excess glandular tissue development
• A combination of both excess fat and glandular tissue
• Sometimes excess breast skin
• Presence unilaterally (one breast) or bilaterally (both breasts)
True gynecomastia means that the enlarged breasts are all breast tissue and pseudogynecomastia means that the enlarged breasts are mostly fatty tissue. Most cases of adolescent gynecomastia are mixed, a combination of enlarged breast tissue and increased fatty tissue.
Other than hormonal changes during puberty, gynecomastia can be caused by certain types of adrenal, pituitary or testicular tumors. Drugs or medications such as anabolic steroids, valium, antidepressants, some antibiotics, ulcer medications like Tagamet, amphetamines, heroin and alcohol can also cause gynecomastia.
Gynecomastia in adolescents should be conservatively observed, because the majority of boys with gynecomastia in their teens will normalize by the time they turn 18. Consultation with an endocrinologist may be considered if the patient's pediatrician deems it necessary to rule out any unusual hormonal imbalance. The individual should be counseled and educated about the condition, and made to understand that it is a fairly common entity and much reassurance should be offered. The cancer drug Tamoxifen has been used to treat this condition, with mixed results. If psychological issues arise, they should be referred to a mental health expert.
Layered clothing is a useful ploy to camouflage the body when applicable in cooler weather. Those afflicted should be encouraged to try diet and exercise, including weight lifting to increase girth of the pectoral (chest) muscles. If psychological issues become overwhelming, plastic surgical consultation may be considered before age 18.
Plastic surgical intervention should be considered in patients whose condition does not improve by their 18th birthday (if it bothers them), or less commonly at age 16 or 17, if peer taunting or psychological issues escalate. Young men with this condition (18 and older) may consider surgical intervention at any time, as long as they are healthy, nonsmokers and have reasonable expectations. A vigorous diet and exercise program should be encouraged first to possibly obviate the need for surgery.
Plastic surgical options include liposuction, with or without direct excision of firmer breast tissue. Sometimes it is necessary to trim excessive skin, but plastic surgeons strive to place scars in locations easily hidden by lines and folds of the body. Recovery is usually quick, and patients are encouraged to temporarily wear an elastic garment or snug elastic athletic T shirts to help decrease swelling and speed recovery. Health insurance may or may not cover the procedure, as policies differ greatly.
Increased awareness of gynecomastia within our communities will empower afflicted men and boys to seek out treatment. Years of personal experience with this operation have demonstrated a very high satisfaction rate, especially in teenagers. I have seen literal transformations with regard to confidence and exuberance. If surgery is considered, be sure to consult with a board certified plastic surgeon.
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