Gynecomastia is the enlargement of glandular breast tissue in males. Causes of pathological gynecomastia may include: testicular or pituitary tumors, some syndromes of male hypogonadism, genetic disorders/congenital endocrine conditions and cirrhosis of the liver. Gynecomastia is the side effect of many drugs, such as: anabolic steroids, cannabinoids, psychotropics, antihypertensives and estrogens for prostatic/testicular carcinoma.

Pubertal gynecomastia occurring in teenaged boys (usually between 13-15 years of age) usually spontaneously resolves in more than 90% of patients within two years. Pubertal gynecomastia persisting beyond two years is severe and usually associated with pain in the breast from fibrous tissue stroma and distention.

Surgery for gynecomastia may be considered when clinical suspicion of breast cancer is high.

Surgery for gynecomastia may be considered when all of the following are met:

• Patient is over eighteen (18) years of age with persistent breast tissue for over two years;
• A functional deficit exists, such as pain, unresolved by pharmacological intervention.
• Prescription drug induced gynecomastia that does not resolve after 6 months of drug therapy cessation. Some drugs that are associated with the occurrence of gynecomastia include, but are not limited to Estrogens, androgens, spironolactone, digitalis preparations, flutamide, ketoconazole, cimetidine, and some psychiatric drugs. Drugs of abuse that can be associated with gynecomastia include illicit use of steroids, alcohol and marijuana.
• An endocrine disorder has been ruled out OR if endocrine disorder exists, a 12- month period of conservative therapy must be followed prior to surgical intervention.
• Patient is within 12% of ideal body weight, according to the most recently published Metropolitan Life Insurance Company charts or meets the equivalent BMI value.

1. Blue Cross and Blue Shield of New York, Number 7.01.56
2. Blue Cross and Blue Shield of North Carolina, SUR 6100
3. Highmark Medical Policy Bulletin, Number S-28
4. BCBSA Medical Policy Reference Manual, 7.01.13; 4/15/02
5. Anthem Medical Policy (Policy #SURG.00023)

Weights at ages 25-59 based on lowest mortality. Weight in pounds according to frame (in indoor clothing weighing 5 lbs. for men and 3 lbs. for women; shoes with 1" heels)