It is not uncommon to see some degree of breast enlargement early in puberty. Often the onset of puberty can be as early as 12 years of age. When the breast increases in size at this age the enlargement is usually temporary and often returns back to normal in 1-2 years. The usual finding in this case is a firm fibrous mass just below the areola. This may be accompanied by increase in the surrounding fatty tissue. When this is noted early in puberty it is reasonable to delay treatment for 1-2 years anticipating a return to normal. Commonly the hormonal imbalance stabilizes at approximately 15 years of age. Gynecomastia persisting beyond this age can be considered for surgical correction. Very often even small to moderate amounts of gynecomastia can result in social withdrawal during the teenage years. When persistent gynecomastia and noticeable social withdrawal is present at this age it is reasonable to proceed with surgical correction.