Breast cancer incidence in adolescent males undergoing subcutaneous mastectomy for gynecomastia: Is pathologic examination justified? A retrospective and literature review

Background: Most medical centers routinely perform or require the pathologic examination of breast tissue that is excised for adolescent gynecomastia; however, its utility is questionable, given the benign nature of the condition. Methods: A retrospective chart review was conducted to examine the incidence of pathologic abnormalities in patients 21 years or younger who had undergone subcutaneous mastectomy for gynecomastia. A literature review was also performed to determine the historical prevalence of cases of atypia or malignancy in cases of adolescent gynecomastia. Finally, an informal survey was performed of major children's hospitals regarding their practice of pathologic examination for adolescent gynecomastia. Results: The chart review demonstrated that over the past 10 years, 81 patients with gynecomastia underwent subcutaneous mastectomy. All cases were negative for malignancy, with only one case of cellular atypia. The literature has historically reported six cases of carcinoma and five cases of atypia. Of 22 survey respondents, all either routinely performed or required pathologic examination of breast tissue excised for gynecomastia. The out-of-pocket cost for self-pay patients to perform pathologic examinations has been quoted at $1268 for bilateral cases. Conclusions: The incidence of malignancy or abnormal pathology associated with gynecomastia tissue in the adolescent male is extremely low, and given the associated costs, the pathologic examination of breast tissue excised for gynecomastia in individuals 21 years of age or younger should be neither routinely performed nor required but should be performed only when desired by either the patient, the patient's family, or the managing physician.