A Mother's Story April 10, 2000
I am no expert. I am a parent who saw a problem and was determined to get help. I did not know what Gynecomastia was and I never heard of anyone having it. This is the story of my son's problem.
When my son, Tom, was 12 years old, my spouse and I felt that he was going through puberty because his breasts looked swollen, especially in the areola and nipple area. There were other boys that looked this way also, so we didn't think much of it. Boys at that age are self-conscious about their changing bodies, so when summer came and he went swimming, we didn't think it odd that he swam with his t-shirt on. By age 14, however, he was still swimming with a t-shirt on and would not take his shirt off around any of us. Also, he constantly pulled at his shirt, wet or dry, and walked with shoulders noticably stooped.Still, it hadn't really sunk in.
When we went to the doctor for his annual checkup, they had him remove his shirt. As he sat hunched over with hands covering his chest I noticed for the first time that he had breasts much like a girl. That really upset me because I knew it could not be normal. He was obviously very embarrassed. Not wanting to provide further embarrassment, I waited until we returned home, then called the doctor to discuss my observations. When I inquired whether "they noticed it" the doctor replied that "it usually goes away in a year or two, let's wait and see." How many of you have had that response? Well, I didn't take him to the doctor the next year so as not to embarrass him again.
But at 16, I felt he needed to have something done. This could not be normal. Also, there had been a big problem at school with some of his "best friends" making fun of him. They had been saying things like "No girl will ever go out with a boy that has boobs bigger than hers!" and "Why would girls ever want to go out with a boy that needs a bra?". At 16, remarks like this are very harmful to a guy's self esteem. When Tom had to talk to my spouse and me about this incident because of some retaliation he inflicted, it was the first time we had ever talked about his breasts being a problem. "Talked" is somewhat of a misnomer. He actually broke down in tears, saying that the tormenting had been going on for years. We had always avoided discussing this with Tom because we thought "maybe it didn't bother him". Boy, were we wrong! Looking back, I think we just didn't want to confront the situation.
After the school incident, things calmed down due to school letting out for the summer. Tom went to Missouri with his grandmother and my sister-in-law's parents, to visit with my brother and his kids. One of the sister-in-law's parents pulled me aside after visiting with us for awhile and said, "I see that Tom has breasts. My brother had breasts and it was hormonal. When he got on the right dose of hormones, the breasts went away. Maybe you should have Tom checked." That clinched it for me. I knew we had to do something and couldn't avoid it much longer.
I made an appointment for a checkup. A day before the appointment, I called the doctor's office. I told the nurse that I really wanted to talk to the doctor ahead of time about this issue and that I wanted him to examine Tom to find out what was wrong with his breasts. The doctor called me and didn't seem to think that there was a problem; I felt like he thought I was just a making a problem. Tom fought me left and right about going the next day but I told him that I would not go in with him when he was examined and that he could keep his undershirt on until the doctor examined him. Once the doctor took a close look at him, he immediately did a hormone test to see if his hormone levels were up to par. The doctor talked to Tom and me after the examination and said that Tom definitely had gynecomastia and that there were several options.
Up to that point, I had never heard that term before. He told us that if the hormone levels were off, then it could be treated with hormones. If not, since he had this problem since age 12, it probably would not go away, although there was a chance that it might. Or, we could opt for surgery which is usually not covered by insurance. He gave us the names of some pediatric surgeons that the doctor said, "If it were my son, I would take him to see these guys before anyone else!" That is a pretty good reference for anyone needing surgery. They were not just buddies of his. I called and inquired with several cosmetic and reconstructive surgeons to determine if they were familiar with gynecomastia. When we decided on one who seemed the most receptive to our concerns, we scheduled a consultation appointment.
Once there, we asked many questions. The surgeon didn't mind answering and spent ample time with us. He was not intimidated or irritated by our questions. I remember calling the surgeon later just to ask him some follow-on questions relating to the procedure and options other than his recommendation. Once again, we felt we made the right choice of a surgeon because of the time he took to answer our questions and actually discuss the pros and cons of each approach. This simple act of courtesy did wonders to make me feel better about the surgery.
The next problem was insurance coverage. Unfortunately, we were covered by an HMO - what could be worse? At the surgeon's office, we were told that we could file for predetermination to see if the procedure would be covered, but, unless there was pain involved, the coverage would probably be declined.
We went ahead and filed just to see what the reaction would be, and were immediately turned down. The nurse told us that sometimes, if we kept trying, they would approve it. So we filed again. This time we submitted pictures of Tom's breasts so they could see that a problem did in fact exist. That approach didn't do any good, either. When the nurse called and said that we had been turned down again, we were discouraged because we really didn't have the money to pay for the surgery. We would have to get a loan. She then told us that we could contest the decision and go before the HMO's citizen review panel and plead our case. Like the nurse said, the squeeky wheel gets the grease. We decided to go for it. What did we have to lose? By coincidence, the day we received notice of the date that our case would be heard by the review board, we received a letter from our surgeon stating that our appeals appeared to be hopeless, and that there was nothing more he could do.
My spouse and I went to the review board meeting without much hope. We took pictures of Tom with and without his shirt so that the board could see that even when clothed, his breasts were obvious. We told of the relentless teasing and how the mental strain was affecting Tom's grades and attitude. We provided copies of emails and posts from this forum (identities deleted) to share the horror stories and nightmares that affect the mental status of men with this condition. We gave them letters from our surgeon and from the family physician saying that this condition had the possibility of causing mental health problems if it were not corrected. We pushed the mental well-being aspect of it because any other way seemed like a dead end. The board asked several good questions. The last one was from a retired physician, who had a sour attitude about the whole meeting. His question was,
"Why do you think that your son should have the surgery when it clearly states in your contract that it was considered cosmetic unless there was severe pain involved?" We told him that pain is not always clearly defined. Mental pain and the stresses that are entailed and the problems that come with it can be just as real as physicial pain and that we felt he was definitely causing mental distress. We also commented that the HMO contract specifically covers cosmetic surgery after female mastectomies, "to restore a sense of normalcy." We asked them to consider that all we wanted for our son was to have that same sense of normalcy - the chance to interact with members of his own, and the opposite, sex without fear of ridicule. The board thanked us for coming in and we very politely thanked them for letting us plead our case. We left feeling fairly hopeless but at least we tried.
By the time we arrived home, there was a call from the review board saying that they had given their approval for the surgery and that paperwork would be sent shortly! That was a great day! We didn't have to pay the surgeon, the hospital, or the anesthieologist anything except our minimal co-pay. Within minutes, we called our surgeon to advise him of the outcome and to schedule a day for surgery.
The surgeon was very clear on all the aspects of the procedure. It was to be a bilateral masectomy. He felt that Tom, who was husky but not overweight, would not benefit from just liposuction. It was the breast tissue that would be removed, not the fat around it. An incision would be made around the areola, and the skin pulled back to cut a shape similar to an ice cream cone to remove the breast tissue. That would be followed by cutting the fat that was there and resectioning it so that Tom didn't get that "caved in look".
Post-op, he told us that he removed a quantify of tissue about the size of a tennis ball from each breast. The scars are hardly noticible because they blend in with the color of the areola. It has now been about four months since the surgery.
Tom is like a new person. He feels good about himself. No one except his band teachers even knew he had the surgery because we scheduled it to coincide with the Christmas break. The only reason the band teachers knew was because they scheduled a practice session during the holiday, so we felt we had to let them know that Tom could not lift anything during that time.
He wore a compression garment for about 3 weeks but that didn't show. (The compression garment is to bind the skin to prevent a lot of swelling and to help the inside skin to adhere to the chest again.) He just wore his sweat jacket over a t-hirt to hide any signs of it. He recovered very fast. The first 3 days, he was a bit uncomfortable, but by the end of the first week, he was wanting to drive again. The doctor told him he couldn't drive until he could lift his arms over his head - the rationale being that driving in and of iteslf was not a problem, but that any quick reaction to avoid an accident (or flailing about in an actual accident) could tear the tissue. Tom was so glad to have the surgery that he didn't push the driving issue. For a 16 year old boy, thats something! Tom looks very normal now. I know that 4 months is not a year but the relief that has been provided has been great.
Some of you may be contemplating surgery, maybe some can't do it for other medical reasons; perhaps some accept their condition as-is. For Tom, surgery was the best answer. It is not that easy for everyone, but I wish it were.
Men have lived with this condition, silently trying to hide it for too long. Maybe what it is going to take, will be an educational push to fight the insurance carriers. Write letters to whomever it takes to get noticed. Write letters to your state insurance regulators. Let the medical establishment know how you feel. Men, you have to speak up! I don't think that means that you have to lift your shirts on TV. I don't think you should have to lift your shirts at all. Women don't have to make anywhere near the effort to obtain reconstructive surgery after a mastectomy.
This forum is a great support group for all of you and this is where it starts. The more the public is aware of it, the more they'll realize that it isn't some kind of "freak" thing. This is a medical problem, not a cosmetic one.
One more thing - if any of you are teens that want help but are scared to talk to your parents about it, my advice is TELL THEM. They probably notice the problem but think that it doesn't bother you that much if you don't say anything to them. It's funny; having a housefull of boys, we talk very freely in our house about bodily functions and male anatomy, yet Tom's condition was one subject that was not broached. If nothing else, email this story to them and let them read it. That will let them know. Don't just feel bad and do nothing thinking that it will go away on its own. Most of the guys on this forum KNOW that it doesn't "just go away." At the least, you can start the process on your own the next time you visit your doctor by asking if your hormone levels can be checked. That is a start in the right direction.