Hello, and thank you for your question regarding what to do with pre-pubertal gynecomastia, which is diagnosed in a teenager, and whether you need surgery for your breasts. Thank you for your history and your pictures. There can be many reasons for gynecomastia. There are four primary causes of gynecomastia: physiologic, medication-related, medical conditions, and idiopathic. Physiological causes are common in newborns, teenagers undergoing puberty, and older males 70% of adolescent boys developed temporary breast enlargement due to fluctuating hormones. Medications like finasteride, calcium channel blockers, alcohol, marijuana, and anabolic steroids can all increase male breast tissue. Medical conditions can also increase gynecomastia. Medical conditions include hypogonadism, testicular tumors, cirrhosis, hyperthyroidism, and obesity. I assume your physician has thoroughly evaluated you. If all of those causes are normal or have been corrected, then your gynecomastia treatment would be considered aesthetic or cosmetic. Therefore, that means you do “need” gynecomastia surgery to improve your health. In your case, undergoing gynecomastia surgery would be elective and would be performed to make your chest look better. In terms of treatment, it depends on the results of the physical examination. If you have hard masses underneath the nipple areola complex, you will need an incision and removal of the glandular tissue. If the rest of the chest is soft, then this is usually treated with either excision or VASER, combined with Micro-Air Power-Assisted liposuction (a.k.a. PAL) and Renuvion radiofrequency (or RF). For glandular tissue removal, an incision is placed just underneath the areola. Treatment is usually done under general anesthesia and requires about 2 to 4 hours of anesthesia. Allow for a 5- to 7-day recovery period. In general, the majority of gynecomastia surgeries involve both glandular tissue removal (“gynecomastia mastectomy”) and liposuction. Overwhelmingly, patients are satisfied with their treatment. Your previous providers are correct; aside from addressing the other medical conditions mentioned above, the only way to effectively treat your gynecomastia is through surgery. Good luck. I hope I’ve answered your question regarding the fact that you’ve been diagnosed with pre-pubertal gynecomastia as a teenager, and whether you need surgery for your breasts. Sincerely, Dr. Katzen, MD, MBA. (Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery, and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)