Puberty-related breast tissue resolves on its own in most boys within two years. Operating during that window risks removing something that was leaving anyway.
Because the hormonal balance is temporarily uneven. During puberty oestradiol rises before testosterone catches up, and breast tissue responds to that ratio rather than to either hormone alone. The result is a tender, firm button under one or both nipples, often asymmetric, often painful to the touch. It is a physiological event, not a disease, and it appears in a large proportion of boys somewhere between the ages of twelve and fifteen.
We ask families to wait until the tissue has been stable for at least two years and puberty is complete, which usually means eighteen or older. Most pubertal gynecomastia resolves within that period without any treatment. Operating earlier carries two specific problems: the chest is still changing shape, so the contour we create today may not match the chest of twenty-one, and remaining hormonal activity can regrow tissue behind the scar.
Severe cases with real psychological impact are handled differently. If the tissue is large enough to be visible through clothing, has been present and unchanged for more than two years, and the boy is avoiding sport, swimming or school changing rooms because of it, waiting has its own cost. We assess those cases with a paediatric endocrinologist involved, and we require a parent at every consultation. The threshold is deliberately high, and we decline more of these requests than we accept.
Get it examined rather than ignored. A doctor should confirm that the lump is ordinary pubertal tissue and not something that needs investigating, particularly if it is on one side only, growing quickly, or accompanied by other symptoms. Beyond that, keep body weight in a healthy range, avoid any supplement marketed for muscle gain without knowing what is in it, and check back annually. When the young man is eighteen and the tissue has not gone, surgery from €2,200 is still there.
In most boys it does, usually within two years of first appearing, as testosterone catches up with oestradiol. Tissue still present two years after puberty finishes is unlikely to resolve on its own.
We prefer eighteen, with growth complete and the tissue unchanged for at least two years. Younger cases are considered only when the tissue is severe and stable, with a parent present and an endocrinologist involved.