Surgical Treatment of Gynecomastia Improves Quality-of-Life in Adolescents: A Longitudinal Cohort Study
Joseph M. Firriolo, MD, Carolyn M. Pike, MPH, Laura C. Nuzzi, BA, Arin K. Greene, MD, MMSc, Brian I. Labow, MD.
Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
BACKGROUND: Gynecomastia, the benign enlargement of male glandular breast tissue, has been associated with psychosocial deficits for affected adolescents. This longitudinal cohort study was performed to evaluate whether surgical treatment effectively alleviates the associated negative health-related-quality-of-life (HRQOL) symptoms of adolescent gynecomastia.
METHODS: Validated surveys were administered to adolescents with persistent gynecomastia (>3 years) and unaffected male controls, aged 12-21 years, from 2008-2017: the Short-Form 36v2 (SF-36), Rosenberg Self-Esteem Scale (RSES), and Eating-Attitudes Test-26 (EAT-26). Patients with gynecomastia completed baseline surveys preoperatively and following gynecomastia correction at 6 months, 1 year, 3 years, and 5 years follow-up. Control subjects completed baseline and follow-up surveys at the same time intervals.
Thirty patients undergoing operative gynecomastia treatment and 63 male controls were included. Gynecomastia and control subjects were comparable in age (16.5 ± 2.0 and 15.7 ± 2.4 years, respectively, p=0.108), though a higher proportion of patients with gynecomastia were overweight/obese (80.0%) compared to controls (33.3%; p<0.001). Patients were followed-up for an average of 28.3 months. At baseline, subjects with gynecomastia scored statistically significantly less favorably than controls in five SF-36 domains (general health, vitality, social functioning, role-emotional, and mental health), the RSES, and the EAT-26 (p<0.05 for all). By 6 months follow-up, postoperative subjects were scoring similarly to controls in four of the aforementioned SF-36 domains (vitality, social functioning, role-emotional, and mental health) (p>0.05 for all), and by 1 year follow-up postoperative subjects scored similarly to control subjects in all survey measures (p>0.05 for all). Scores remained comparable at 3 year and 5 year follow-up (p>0.05 for all). These trends were largely unaffected by patient age group (i.e. <18 years and >18 years), and were not influenced by overweight/obese BMI status. Linear regression models, using baseline BMI category as a covariate, demonstrated no statistically significant difference in patients' most recent postoperative/follow-up survey scores based on case status (p>0.05 for all).
CONCLUSIONS: These results illustrate the benefit of operative treatment on HRQOL for adolescents with gynecomastia. Within a year of follow-up, HRQOL in postoperative patients was comparable to controls, and measureable deficits in psychosocial well-being were alleviated. These benefits were largely unaffected by patient age and BMI category. Patients, parents, and providers should be aware of the positive impact that surgical intervention can provide adolescents with gynecomastia.
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