Gynecomastia: Not just a cosmetic issue

When most people hear about procedures to remove excess breast fat, tissue and skin, they associate it with women. But gynecomastia is enlargement of the male breast tissue, and male breast reduction procedures were up 5% in 2012. Gynecomastia commonly occurs in boys during puberty, with up to 69% of adolescents affected by the condition at some point in their lifetime. Gynecomastia can even persist into adulthood. Surgery to correct this condition is usually recommended for these patients.

Although treatment guidelines for gynecomastia are widely practiced, the psychological impact of gynecomastia on adolescent boys has remained largely unknown. Until now. In a new study released today, boys with gynecomastia were compared to healthy, unaffected peers of the same age and gender with respect to physical, social and emotional well-being. The adolescents with gynecomastia were found to have significantly lower measures of mental health, self-esteem and social functioning. Boys with gynecomastia also had higher rates of disordered eating thoughts and behaviors than their peers.

The severity of the gynecomastia or the patient's body mass index (BMI) did not affect the degree of impact. Merely having the breast disorder was enough to show these physical, emotional and social deficits. Even the mildest gynecomastia can negatively affect the psychosocial well-being of a young man. The physical health of males with gynecomastia was considerably worse than that of the healthy boys, but was attributed to the higher rate of obesity rather than the disorder.

These findings suggest that gynecomastia is more than just a cosmetic issue. Adolescents with the condition may suffer psychologically as a result of their breast condition. Prior studies have found higher rates of depression, anxiety and embarrassment in boys with larger chests. Parents and patients should be aware of the psychosocial issues associated with gynecomastia, and consider early evaluation for adolescents suffering from this condition, regardless of severity. Early surgical treatment may also be necessary to improve these adverse emotional and social effects.

Despite this evident lower quality of life, the cost of surgical correction for adolescent gynecomastia is usually not covered by most insurance plans. In my practice, only 35% of surgeries for gynecomastia were reimbursed by insurance companies, compared to the overwhelming 85% of breast reductions for adolescent girls. Providers, patients, parents and third-party payors need to recognize the detrimental effects of gynecomastia. Although the physical condition is benign, the negative psychosocial effects of gynecomastia can no longer be denied. Gynecomastia is not just a cosmetic issue.