How do I know if my son has Gynecomastia?

[ElizabethLiz]

My son is 12 years old and has enlarged breasts.  Over the past year my son's chest has become noticeably larger and he has become self conscious about taking his shirt off in front of anyone.  How do we know if this is gynecomastia?

[Dr. Elliot Jacobs]

It is not uncommon for pre-pubescent boys and boys going through puberty to have some breast enlargement.  Technically this could be called gynecomastia, which is any enlargement of a male chest.  Would recommend "watchful waiting" for a minimum of two years or more.  Many times the enlarged tissues will spontaneously diminish.  If the breasts continue to enlarge or remain stable but enlarged, then consider a consultation with a gynecomastia specialist to assess the situation. 

You seem to be a concerned parent -- which is to your son's benefit.  All too often, parents will ignore the situation and tell their son to be patient and that it will go away by itself.  The result is a youngster who develops methods to hide the situation, which include refusal to participate in swimming or skins vs shirts basketball, wearing baggy tops, multiple layers of shirts, walking hunched over, etc.  This can also lead to poor performance in school, embarassment, isolation, etc.  The situation can be made worse by a well meaning pediatrician who, despite stable 2-3 year gynecomastia, will reassure the young man that it will disappear when he reaches age 18.  That, too, doesn't happen.  

There is no need for a youngster to suffer the pain and embarrassment of gynecomastia throughout his teen years.  Successful surgical treatment can be done on boys from age 12 through 18.

Bottom line:  be supportive of your son, observe his condition, reassure him and if the condition persists, take him for a consultation.

Good luck!

Dr Jacobs

[Dr. Schuster]

It's good that you are seeing a potential issue with your son. The first thing would be to see his Pediatrician for a general check up and possibly blood test. However, usually the gynecomastia "just happens" and everything is otherwise normal. AND, most pediatricians are generally very conservative and refrain from recommending surgery. However, if the gynecomastia does not resolve within two years - it won't. Also, if it is causing real social issues, it is best treated early. You can ask your pediatrician for a referral to a good Plastic surgeon who does good gynecomastia correction. Otherwise just do your homework locally and go for a consultation. Your son will appreciate the attention and understanding you are giving him, even if it means that the surgery doesn't happen for a short time while you 'wait and see" what happens.

[DrPensler]

Each situation is unique. It is normal to have some modest enlargement of the breast bud as males go through puberty. This enlargement typically recedes with continued hormonal maturation. Some individuals do not undergo recession with time,in addition some individuals have marked enlargement of their breasts during the hormonal fluxes of puberty these cases do not regress and are surgical candidates at an earlier age than the aforementioned group. Some of the early patients with large breasts have underlying medical issues. Also obesity can in and of itself cause gynecomastia during puberty. I always recommend discussion with the potential patient and some images for an initial evaluation along with a short medical history. It's an important developmental period and often difficult for the patient to discuss. The way I usually balance the youngster's reluctance to discuss the issue with the parents desire to what to educate themselves and help is to explain to the patient that even if surgery is indicated it cannot at his age be performed without parental consent. I then stress that the patient should put themselves in their parents position and do whatever is necessary to help fully educate their parents which is what they would require if the tables were turned.

[Litlriki]

If it looks like gynecomastia, it is gynecomastia. This occurs in as many as 70% of men depending on where you read, but 95% of these go away within 3 years of onset.  So when parents bring a child into my practice, I like to know how long they've observed the condition. Often, if it just started, I'll advise patience and watching to see if it resolves. If it's been there a few years already, I don't make them wait at all.  The tough ones are the kids who just told their parents, but maybe the condition has been going on a few years already.  If there's a debate on the timeline and depending on age/level of maturation, I might suggest watching 6 months, and if there's no change, proceeding at that point.