Mastectomy for adolescent gynecomastia associated with lower risk of incident psychiatric diagnosis

Adolescent gynecomastia is associated with psychological distress. However, current literature evaluating the impact of surgical intervention has largely relied on single-center design and patient-reported outcomes, leaving clinically diagnosed psychiatric trends unstudied. This study evaluated whether mastectomy for persistent gynecomastia is associated with differences in incident psychiatric diagnoses among adolescents.

A retrospective cohort study using the Pediatric Health Information System (PHIS) database from 2004 to 2025 was performed. Adolescent males diagnosed with gynecomastia with ≥3 years of follow-up and no prior psychiatric history were included. The primary outcome was incident psychiatric diagnoses (anxiety, depression, eating disorders, or suicidal ideation/self-harm). Propensity score matching (1:2) was performed to balance demographics, socioeconomics, and obesity. Time-varying Cox proportional hazards models were used to account for operative timing.

Of 2605 patients, 130 (5.0%) underwent mastectomy. After propensity score matching, 390 were analyzed (130 surgical; 260 control) with a 4.33-year median follow-up. The surgical cohort demonstrated significantly lower incidence of overall psychiatric morbidity (7.7% vs. 20.0%, p = 0.003), anxiety (5.4% vs. 13.1%, p = 0.031), and suicidal ideation/self-harm (0.8% vs. 6.2%, p = 0.028). Time-varying modeling confirmed mastectomy was associated with a 71% lower risk for incident anxiety (HR 0.29; 95% CI, 0.09-0.94; p = 0.039) and a 54% lower risk for overall psychiatric morbidity (HR 0.46; 95% CI, 0.21-0.99; p = 0.049).

Among adolescents with gynecomastia and no prior psychiatric diagnosis, mastectomy is associated with significantly lower rates of incident psychiatric morbidity compared to nonoperative management. For the appropriately selected patient, surgical intervention may have psychosocial implications beyond physical correction.