Off Their Chests

But even if some older men have made peace with their manboobs, gynecomastia is no joke for many young men—particularly in a culture in which pecs of steel are the norm in the mainstream media. "The problem with adolescent onset gynecomastia is that it's happening at a time when kids are first becoming aware of their bodies," says Yost. "Kids at that point are really interested in fitting in, and this can make them targets for everything from emotional to sexual to physical abuse."

Some boys take to radical weight-loss diets or manic exercise regimens to solve the problem, while others go to extreme lengths to hide it: buying special clothes, wearing multiple layers, hunching over or wrapping themselves in Ace bandages—even gaining weight to shift the emphasis elsewhere. "I spent my teens hating the way I looked, changing in the corner for gym with my back to everyone," writes a young man on Yost's Gynecomastia.org. He says he spent "every sexual relationship" making sure his chest was never seen or touched. Another sufferer, 24, says he hated himself so much during adolescence that he "considered mutilating my chest with knives or scissors."

Impatient teens have few options. They can wait it out and hope the gynecomastia goes away as hormone levels fluctuate; most doctors say to give it two years or so. If it still persists, a doctor can prescribe an estrogen-blocker—a common one is the breast cancer drug Tamoxifen—to reverse the hormone levels. Or, as an increasingly common last resort, there's breast-reduction surgery, a procedure some 20,000 American men—including 14,000 teenagers—underwent last year, making it the fifth-most common male surgery in America, according to the American Society of Plastic Surgeons. "I hated having my shirt off, and all I did was work out," says Andre Zdanow, a 25-year-old New York college student who had suffered from gynecomastia since he was a teen and underwent the procedure last year. "The difference is really night and day."

Braunstein says he encourages teens to wait until they've passed puberty before they seek surgery, but that it can be a "very good option" for those who are cosmetically concerned. Felicia Farino, of Queens, N.Y., let her 10-year-old son go under the knife after he developed breast growth on just one side of his chest—and says it was the best decision she ever made. "Dylan had always been at the top of his game—in sports, in school, at home—and all of a sudden he was withdrawing," Farino says. "It wasn't an easy thing to go through. It was painful, it was expensive and he had to wear a corset. But immediately I saw a complete turnaround. Within a week he was back to his old self."

Plastic surgeons say the procedure today is easier, safer and more effective than it's ever been. The surgery ranges in price from about $4,000 to $10,000 and can take as little as an hour, depending on the size and makeup of the breast, which can range from puffed up nipples to more fully formed breasts. In some cases surgeons use liposuction to remove fatty deposits and glandular tissue, all through a "tiny nick in the skin"—about an eighth of an inch, says Jacobs, who has performed the surgery on more than 1,400 men. In more severe cases a surgeon may need to open up the breast to remove tissue and excess skin, and occasionally even reposition the nipple.

Of course, it's good to keep in mind that not all surgeons are created equal—and the procedure is not without risk. Many pediatricians worry that if surgery is done too early, the hormones that caused the breast enlargement could cause them to regrow. Yost says that breasts grow back following about 30 percent of surgeries. The surgery can also be expensive—and is rarely covered by insurance.