BACKGROUND:
Adolescents with gynecomastia remain a poorly defined population. In addition to physical and emotional consequences, patients with gynecomastia are often prejudged as sedentary or overweight. There is significant variation in the reported prevalence of adolescent gynecomastia. This retrospective study reviewed etiology, demographics and outcomes of surgery for adolescents with this condition.
METHODS:
An IRB-approved query of our pathology database was performed for gynecomastia specimens between 1997-2008. Data were extracted on demographics, medical history, operations, and follow-up. BMI-for-age percentiles were calculated using the Centers for Disease Control (CDC) and Prevention Child and Teen BMI Calculator, which takes into account age and gender. Patients were designated as normal-weighted if they fell below the 85^th percentile for their age, overweight if they were in the 85^th percentile up until (but not including) the 95^th percentile for their age, and obese if they fell equal to or greater than the 95^th percentile for age, as per the CDC child and adolescent guidelines. Chi square or Fisher’s exact tests (where appropriate) were used to compare categorical variables; t-tests (with equal variances) were used to compare continuous variables (Stata/IC version 10.1, College Station, Texas).
RESULTS:
Sixty-nine patients were included (89.9% bilateral). Mean duration preoperatively was 3.5 years (SD 2.3, range 0.25-10 years). Mean age at surgery was 15.7 years (SD 1.7, range 12.2-20.6 years). Twenty-three patients (33.3%) were normal-weighted by BMI-for-age criteria. Forty-one patients (59.4%) reported psychological stress secondary to gynecomastia; 19 (27.5%) refrained from physical activity or peer socializing as a consequence. Eighteen patients (26.1%) had potential medical etiologies: 8 had abnormal serum endocrine values and/or clinical endocrinopathy; 5 were on medication with gynecomastia as a listed potential side effect; 2 were chronic smokers of marijuana; 3 had cirrhosis/chronic liver dysfunction. Major complications (surgical hematoma evacuation) occurred in 4 patients (5.8%) and minor complications in 19 (27.5%).
Although obese patients required additional skin resection compared with non-obese patients (P=0.009), complication rate and satisfaction did not differ from non-obese patients (P=0.47, P=0.33 respectively). Duration of gynecomastia was significantly higher in overweight/obese patients compared with their normal-weighted counterparts (3.9 years versus 2.7 years, respectively; P=0.0383). Age at surgery was significantly lower in overweight/obese patients when compared with normal-weighted patients (15.3 years versus 16.5 years, respectively; P=0.0139). Overweight/obese patients reported psychological stress related to gynecomastia more frequently compared with normal-weighted patients (69.6% versus 39.1%, respectively; P=0.015).
CONCLUSIONS:
Adolescent gynecomastia is not simply a byproduct of obesity. While obesity may be related to gynecomastia in some cases, a significant percentage of affected patients are in fact normal-weighted by BMI-for-age criteria. In 26% of patients, an etiology can be found and appropriate work-up should be undertaken in all. Obese patients have similar outcomes and do not have higher complication rates, although surgery may be more extensive.