✍️ When should you undergo Gynecomastia surgery?

Traditionally it was viewed that one should undergo Gynecomastia surgery only after puberty and around 16-18 years. Unfortunately, many teenagers spend their entire teenage years waiting for the surgery and are subject to ridicule and embarrassment during this critical time in their lives. Many people even think that Gynecomastia resolves on its own after puberty which is a very rare occurrence. It’s important to notice the state of the breast gland for a period of two years. If it has increased or is the same, then it’s prudent to plan the procedure. The decision to operate is based not only on the diagnosis of gynecomastia but also on the physical and mental maturity of the person and his capability of understanding the surgery as well as the ability to cope with the post-op pain and to follow the post-op care regimen. Surgery has been successfully performed on hundreds of young men from ages 12 through 18. Obviously, this decision is made is on an individual basis. 

One parent in 2014 met me with their son who was studying in 11th. They were worried about the sudden drop in his grades and his low self-esteem. They had taken him to a psychiatrist too. The boy was on medication as he did not fully disclose the issue to the psychiatrist. Only later did he reveal gynecomastia to his father who in turn got him to meet me. The boy had in the last four years been under severe psychological impact apparently as his friends poked fun at him for his breasts. He started wearing loose-fitting shirts on top of a male bra. Yes, you read that right; a male bra.

The male bra is actually a compression vest that is actually used post-surgical correction for a few weeks for the surgical swelling to reduce. Many misguided boys wear it under their shirts to compress the breasts hoping that it would not show up on top of clothes and also that wearing it long enough would make the gland disappear. Some others try bandaging, where they roll a tight length of a bandage or a cloth in order to compress the glands against their chest to hide it better. Some boys end up getting their skin damaged and even sustain rashes that have to be treated independently. They occur due to the tightness and the subsequent skin damage and irritation.

Examples of skin damage and pigmentation due to overuse of Male Bra (Chest compression garments)

The extent to which some men go to for correction of the breast is quite baffling; especially in these days where a simple google search reveals that surgery is the straight forward option.

In August 2018, a very important and systematic meta-analysis was published on the psychological impact of gynecomastia and surgery. Meta-analysis is like an analysis of many research projects under one umbrella. In such studies, various other research patterns and results are analyzed to give us a better and clearer understanding of the issue being researched on. This study was published in the Gland Surgery journal by Martin Sollie from Denmark. They analyzed over 500 research papers on the topic. They too noted that gynecomastia impacts the general health, functional capacity, social aspects, vitality and mental health of the individuals. And all these were significantly and objectively improved once it was corrected by surgery. This is a seminal piece of information on the often neglected psychological aspects of the male breast. There are many more detailed and meticulous trials and studies that second this conclusion. 

Men older than 45 years suffering from gynecomastia are also candidates for surgery but must understand that the skin may not totally tighten after the surgery is performed since they may have lost some elasticity in their skin through the natural process of aging. Such candidates also require more blood tests and other investigations before surgery.