What is gynaecomastia?
Gynaecomastia is the growth of breast-gland tissue in boys. During adolescence this is quite common: in a significant proportion of pubertal boys it appears, usually under the nipple, as a small, sometimes tender swelling of tissue. It can be one-sided or two-sided. Although noticing it is often a source of anxiety for the boy himself, it is medically benign.
It needs to be distinguished from the fat accumulation in the chest area seen in overweight children (pseudo-gynaecomastia); in true gynaecomastia what grows is not fat but gland tissue. The distinction is made by clinical examination.
Why does it happen?
The main cause of gynaecomastia in puberty is the readjustment of the hormonal system during this period. During puberty the balance between male and female hormones can change temporarily; this short-lived imbalance can stimulate the breast tissue for a while. As the hormones mature and reach balance, this stimulation usually disappears.
For this reason pubertal gynaecomastia is mostly a temporary and physiological (a normal part of development) condition. Less commonly, certain medications, hormonal diseases or other medical causes can contribute to gynaecomastia; these possibilities are evaluated by a doctor if the picture is not typical.
Its course and when to evaluate
Pubertal gynaecomastia, once it begins, mostly regresses on its own within a few months to a year or two; in most adolescents no special treatment is needed and follow-up is enough. Explaining to the boy during this time that the condition is common, temporary and benign markedly reduces his anxiety.
That said, some situations require evaluation: the breast tissue being very large, growing rapidly, marked pain or a one-sided hard/suspicious mass, failing to regress for a long time (for example more than two years), or appearing in a pre-pubertal child. In these situations the doctor evaluates to clarify the cause and, if needed, considers the options.
Emotional support
Although gynaecomastia is medically benign, it can be socially and emotionally challenging for the adolescent; body image, embarrassment and peer anxiety are intense in this period. So it is important to address the topic in a non-judgemental, supportive and informative way. Knowing that the condition is common and usually temporary is reassuring for most adolescents.
If the adolescent is clearly distressed or the condition is affecting his social life, these feelings should be taken seriously and shared with the doctor. Both medical assessment and, where needed, psychosocial support help the adolescent get through this period healthily. Decisions about appearance should always be made with a doctor’s assessment. For most adolescents the strongest support is knowing how common and temporary the condition is; this knowledge alone can markedly ease the embarrassment and anxiety felt, and help the adolescent meet his body’s changes in a healthier frame. A parent’s calm, informative and non-judgemental attitude is also the most valuable support in this process; because it helps the adolescent see this temporary change not as a flaw but as a natural stage of development.