Generally, gynecomastia is a benign condition. Longstanding cases do not require histologic examination of surgically removed tissue. Rapid changes in the size of the breast, especially when unilateral in nature, may represent a malignancy particularly when pharmacologic manipulation can be ruled out. Also, changes in breast size in a patient with Klinefelter syndrome should be viewed with caution.
Surgical intervention is indicated in patients for diagnostic purposes or, most commonly, for patients who request treatment for physical modification. Most patients who visit a plastic surgeon request treatment for improvement of the obvious physical deformity which enhances psychological and physical wellbeing. These patients seek treatment because they find that the condition, which is readily apparent in everyday life, adversely impacts day-to-day activities under various circumstances. The physical deformation necessitates behavioral modifications that have numerous implications in the lives of the patients who are affected. Patients wear loose clothing and often avoid exposure in showers and swimming pools. Patients in high school and college are reticent to participate in any athletic activity that may directly or inadvertently require removal of one's shirt, exposing the chest.
Patients with gynecomastia typically slouch forward and roll the shoulders toward the midline in an effort to camouflage the deformation. The aforementioned posturing has a submissive connotation to the public with whom they interact. Patients return for postoperative appointments standing tall. In cases involving teenagers, parents typically remark "I have been trying to have him stand up straight for years!" The postural changes alone, which result at all age levels both sitting and standing, have numerous positive implications in peer-to-peer interactions. The confidence a patient gains after surgery becomes a life-changing event.