Gynecomastia is a cause of considerable psychosocial discomfort, stress, and worsening of self-image in adolescent boys. It is important to understand these concerns in order to provide proper management. Many parents casually neglect the issues raised by the boys only to later realize the psychological effects of a poor body image.

Many parents attribute adolescent gynecomastia to fat. A rapid increase in obesity among children and adolescents results in a higher number of patients presenting with breast enlargement and disproportionate diagnoses of ‘pseudo gynecomastia’. Despite the fact that obesity causes pseudo gynecomastia, which is a proliferation of fat rather than breast glandular tissue, true gynecomastia is also associated with higher body weight. Many studies like ones by Rivera et al. indicated that there is a correlation between pubertal gynecomastia and higher BMI (Basal Metabolic Index) percentiles (Reference). Kulshreshtha et al also reported that most of the patients (64%) with breast enlargement were obese as per scientific Coles criteria (Reference).

It is common to notice higher BMI values than the general population according to the Centers for Disease Control (CDC) growth charts in gynecomastia patients. However, there is no relationship between BMI and breast size. Despite the fact that many overweight children (57.1%) succeed in losing some weight, breast size was not reduced in any of them and weight changes did not affect sex hormone levels (Reference). This observation, that weight loss alone will not correct true glandular breast enlargement is consistent with that reported by many other authors (Reference 1, Reference 2).

It should be also underlined that in the majority of our patients the breasts do not show a drastic increase in size with age. Adolescents with gynecomastia should be encouraged to lose weight, but it does not treat the underlying breast tissue.

Surgical management of pubertal gynecomastia may be considered in obese or non-obese male adolescents who present with persistent breast enlargement after a period of observation of at least 12 months, breast pain or tenderness, and/or significant psychosocial distress. Obesity is not a contraindication to the surgical approach. Liposuction techniques are helpful in those patients with considerable fat deposition in the breast during the removal of the glandular component. The aim of surgical treatment is to achieve a normal appearance of the masculine thorax with the smallest possible scar. The surgical treatment of gynecomastia requires an individualized approach.

In conclusion, teenage boys who have persistent gynecomastia after the end of pubertal development and adolescents who have concerns about the cosmetic correction can undergo gynecomastia surgery. Therefore, the decision to perform surgery depends on the degree to which this condition has affected the quality of life, psychology and on their desire for cosmetic correction