Adolescent and Teen Male Gynecomastia: Causes and What Can Be Done

What Is Gynecomastia?

Gynecomastia, also known as "man boobs", is a common condition in which boys' and men's breasts swell and become larger than normal. It is caused by an increase in the amount of breast gland tissue brought about by an imbalance of estrogen and testosterone hormones. It occurs in 65 to 70 percent of boys and men worldwide and can affect one or both breasts. 

Gynecomastia can happen at different phases of a person's life. These include:

At Birth

More than half of male newborns have enlarged breasts or breast buds. This is due to the mother's estrogen levels. The enlarged breasts will usually go away within a few weeks.

During Puberty

Some degree of breast enlargement occurs in more than half of teenage boys. Fluctuating hormones, including decreases in testosterone and increases in estrogen, causes the growth of breast tissue.

In Adulthood

Men produce less testosterone as they age. They may also have more body fat, which is a stimulant for estrogen production and breast tissue growth.

What Causes Gynecomastia In Adolescents & Teens?

The most common cause is hormonal imbalance, such as an imbalance in the ratio of estrogen to testosterone. Testosterone is the hormone associated with male characteristics, responsible for muscle mass and body hair, while estrogen is associated with female traits, such as breast development. An increase in estrogen in males causes the appearance of female characteristics. During puberty, hormones fluctuate, causing an increase in estrogen levels.

In adolescent boys, most pubertal gynecomastia issues disappear within two years. Nonetheless, the problem still persists among a significant number. 

What Treatment Options Are Available For Gynecomastia Or Enlarged Male Breasts In Adolescents?

Pubertal gynecomastia usually resolves on its own. Therefore, treatment is usually not recommended at first. Instead, the patient's condition will be observed for any changes in size for several months. In most cases, it will disappear within six months to two years. In boys, the condition may develop between ages 10 and 12 and, most commonly between ages 13 and 14. In up to 20 percent of individuals, the condition persists beyond 17.

When an issue is detected, it is best to seek a qualified doctor's advice. In the following years, when a person has gone through adolescence and the condition has not resolved or is not responding to any form of treatment, surgery would be the best permanent solution for gynecomastia (enlarged male breasts). In adolescents, gynecomastia surgery is very effective because of the patient's young and elastic skin, which can contract more easily.

When is the best time to schedule the procedure?

Given a student's hectic school schedule, the ideal time to consider having the surgery would be during the school holidays. This would give the child ample time to rest and recover.

Medical consultation and evaluation

The ideal first step is scheduling a private consultation with a doctor experienced in treating gynecomastia to determine the situation and what can be done. During this consultation, a physical examination, assessment of medical history and current health status will be done. The doctor will also advise on what to expect, and recommendations will be made regarding matters related to the recovery process.

Lab testing

Laboratory tests such as bloodwork and/or ultrasound scan may be scheduled according to the doctor's discretion.

No Smoking. No Vaping!

Smoking and vaping are to be avoided – vaping and underage smoking are illegal in Singapore, to begin with! These less-than-desirable habits affect blood circulation, depleting the blood of oxygen. Consequently, it can cause issues during the procedure and even impinge on recovery. 

Stop Taking Certain Medications/Supplements

Do inform the doctor of any medications that the child is taking. The doctor may advise the child to stop taking certain medicines before the surgery. These may include anti-inflammatories, blood thinners, Vitamin E, and herbal supplements.

What is expected during gynecomastia surgery, and how long will it take?

The procedure will be done under local anaesthesia as a Day Surgery procedure. Gynecomastia surgery typically lasts 2 to 2.5 hours, depending on the complexity of the surgery and the patient's clinical condition. 

Possible risks associated with gynecomastia surgery

As with most, if not all, surgeries, risks are involved. Understanding what they are is essential, and weighing the pros/cons to achieve one's goal must be discussed with your child and the doctor.

For gynecomastia surgery, the possible risks and complications may include: 

• Anaesthesia risks - Risks associated with reactions to the anaesthesia administered
• Bleeding (hematoma)
• Breast asymmetry
• Breast contour  irregularities
• Changes in nipple or breast sensation - This may be temporary or permanent
• Wound Infection
• Pain and bruising - These are to be expected but typically subside as the patient recovers
• Poor wound healing
• Possibility of revision surgery
• Reactions to tape, suture materials, glues, topical preparations or injected agents
• Unfavourable scarring
  

What should be expected after the procedure?

Pain, tenderness and soreness are to be expected post-procedure. The doctor will dispense medication to cope with the discomfort. These will gradually subside as your child recovers day by day. It is crucial to adhere to all the advice given by the doctor to facilitate a quick and smooth recovery. As a parent, monitor your child and provide constant reassurance and support. 

What does the aftercare process involve?

The advice given by the doctor will be comprehensive enough to facilitate a smoother and faster recovery. Some of these include:

• The wearing of a compression garment as this will aid in skin firming and reduce post-procedure swelling.
• Wear loose-fitting clothing
• To limit any intensive physical activity or to avoid them as a whole. The doctor will advise when it would be safe to proceed with them. These activities include going to the gym.
• To have adequate and proper rest, sleep and eat well. 
• During the recovery period, itchiness is commonly experienced as the incision wounds are healing. Refrain from scratching where the itch is present.
  

One of the most critical elements of the recovery period is attending the doctor's scheduled follow-up appointments. This will enable the doctor to monitor the recovery progress and make necessary adjustments or interventions. 

What To Do As A Parent

Parental support is crucial. The stigma surrounding gynecomastia is real and can be overwhelming even for an adult.   

Assurance needs to be relayed to the affected person that the condition is treatable. Be patient with them, as apprehension and even fear are common reactions among those afflicted with gynecomastia. Advise them not to seek or fall victim to purported "quick fix" solutions because there is none in reality. Even non-surgical treatments such as fat freezing do not work. The only solution is gynecomastia surgery.

Choosing a qualified gynecomastia surgery doctor in Singapore is important and may take effort. Gynecomastia comes in varying degrees, and only a truly qualified and experienced doctor can diagnose an issue accurately and dispense the appropriate treatment that is effective and, most importantly, safe for the patient.

If your child is exhibiting symptoms of gynecomastia, do not hesitate to schedule a private consultation. It will be in the interest of their health and well-being.

‍Reference

[1] Simon B E, Hoffman S, Kahn S. Classification and surgical correction of gynecomastia. Plast Reconstr Surg. 1973;51(1):48–52.