Gynecomastia (palpable breast enlargement in adolescent boys) is extremely common, and may be found in up to 30-60% of boys. Enlargement typically begins about 1 year after onset of puberty. It is frequently bilateral, but may be asymmetric and develop sequentially. It commonly causes pain and tenderness and may cause nipple discharge. Most cases are idiopathic and do not require an extensive workup. It typically resolves gradually over a period of 6-12 months and does not require surgery.
When is surgery indicated? There appears to be some confusion, among physicians and other health care providers (including health insurance company representatives), regarding the answer to this question. Therefore, we have attempted to summarize current available peer-reviewed literature (published textbooks and journals) regarding this issue. We believe that this summarizes what most knowledgeable physicians would consider to be the “standard of care” treatment.
In summary, although there may be minor disagreements concerning exact numbers, it appears that the generally-accepted standard treatment for adolescents with idiopathic gynecomastia is a period of observation for roughly 1 year. If the disease persists for greater than 1 year (especially if it is greater than 4 cm in diameter), treatment of choice is surgery, with removal of the affected tissue.