Surgical Treatment of Gynecomastia Improves Quality of Life in Adolescents
Laura C. Nuzzi, BA, Joseph M. Firriolo, MD, Carolyn M. Pike, MPH, Arin K. Greene, MD, MMSc, Brian I. Labow, MD
Department of Plastic and Oral Surgery and Adolescent Breast Clinic, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
Background: Adolescent gynecomastia, i.e. benign male breast hypertrophy, is associated with psychosocial deficits and disordered eating thoughts and behaviors. For patients with persistent gynecomastia unresponsive to weight loss or pharmacotherapy, surgery is the only curative treatment. This longitudinal cohort study measures the impact of gynecomastia repair on adolescent health-related quality of life.
Methods: Validated surveys were administered to adolescents with persistent gynecomastia undergoing surgical correction and unaffected male controls, aged 12-21 years: Short-Form 36v2 (SF-36), Rosenberg Self-Esteem Scale (RSES), and Eating-Attitudes Test-26 (EAT-26). Cohorts completed surveys at baseline and postoperatively/follow-up at 6 months, 1 year, 3 years, and 5 years.
Results: Thirty-seven gynecomastia and 68 control subjects were included. At baseline, gynecomastia subjects performed significantly worse than controls in five SF-36 domains (general health, vitality, social functioning, role-emotional, and mental health), and on the RSES and EAT-26 (p<0.05). By the first postoperative year, gynecomastia patients demonstrated significant improvements in five SF-36 domains (physical functioning, role-physical, bodily pain, vitality, social functioning; p>0.05). These results largely did not differ by age and BMI category. Within one year, postoperative gynecomastia patients performed similarly to controls in all SF-36 domains and on the RSES (p>0.05).
Conclusion: Correction of adolescent gynecomastia yielded measurable improvements in physical, social, and emotional wellbeing, largely unaffected by age and BMI category. Within one year, postoperative patients performed comparably to unaffected controls. Providers should be aware of the physical and psychosocial improvements surgery can provide adolescents with gynecomastia. Concerns regarding patient age and BMI should not solely preclude surgery.
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