It is difficult to know that one could change a teen’s life for the better, but may not be given the opportunity to because of financial restrictions.
Dr. Ananth Murthy, director of Plastic and Reconstructive Surgery at Akron Children’s, recently presented at the hospital’s annual Adolescent Medicine Update about the multi-factorial challenges in treating disorders of the breast that affect teenage girls and boys.
The disorders, which cause adolescents to have unusually large or asymmetric breasts, can be painful and socially stigmatizing.
Yet, in many cases, insurance companies don’t cover the surgeries, which can be transformational. Families usually cannot afford the out-of-pocket costs, so the teens don’t get the surgeries.
“Insurance companies view many of these procedures as cosmetic and therefore optional surgeries,” said Dr. Murthy. “Yet the impact on these kids is significant. They endure jeering, and it can really take a toll on their self esteem.”
The disorders are often seen at the onset of puberty and may be related to hormonal influences, particularly estrogen and progesterone.
Dr. Murthy discussed two of the disorders where there is overgrowth of breast tissue, macromastia and gynecomastia.
Girls with macromastia, also known as breast hypertrophy, have uncomfortably large breasts but otherwise normal body weight. Physical symptoms can include shoulder, neck and upper back pain, painful bra strap lesions and skin problems.
Surgical treatment, referred to as a breast reduction, can be performed to decrease the size of the breasts and treat these symptoms.
“Insurance companies often deny the coverage or want the patient to try to lose weight or simply wait until she is older,” said Dr. Murthy. “But it does not go away and, in the meantime, these girls are embarrassed by the unwanted attention. They often refrain from exercise, which can be very uncomfortable.”
Gynecomastia refers to enlarged breasts in men and is fairly common in adolescent boys. Sometimes it resolves spontaneously without the need for surgery, but not always. Boys with this condition often avoid sports, locker rooms and swimming.
Corrective surgery is almost never covered by insurance, since the presence of breast tissue in men doesn’t result in symptoms such as pain. However, the psychological impact of a breast deformity can be very heavy.
Recognizing the financial challenge of many families, Dr. Murthy has worked with the hospital’s chief financial officer to reduce the cost of the surgery and allow patients to pay in installments. The hospital has financial counselors available to help patients as well.
Other adolescent breast disorders that Dr. Murthy treats are Poland syndrome (missing or abnormal muscles on the chest wall), juvenile fibroadenoma (benign breast lesions), and unilateral hypoplasia, a noticeable asymmetry in the size of the breasts.
Dr. Murthy hopes that parents and primary care doctors assist teens in seeking specialized care if any of these conditions are suspected.
Surgical treatment, of any kind, can come with risks and side effects. In the case of breast reduction surgery for adolescent girls, they deserve proper and thorough counseling about issues such as scars, nipple sensation, contour differences and future implications for breast feeding and breast cancer surveillance.
“It’s a sensitive topic,” said Dr. Murthy. “Their bodies are growing and the teen years are an already difficulty time – without added body image concerns.”