Adolescent gynecomastia is common and often regresses spontaneously, but persistent gynecomastia can result in psychological distress. Many view obesity as a root cause for gynecomastia. However, the role of obesity on persistent gynecomastia and its effect on surgical outcomes remains poorly understood. This retrospective study reviewed demographics and surgical outcomes of adolescents with gynecomastia comparing obese/overweight to normal weighted patients. Our database was screened for male "breast" specimens between 1997-2008. Sixty-nine patients were identified. By BMI criteria, 51% were obese, 16% overweight and 33% normal-weighted. Major complications occurred in 4 patients (5.8%); minor complications in 19 (27.5%). Potential etiologies other than obesity were found in 27%. Obese patients require more extensive operations (P = 0.009). Obese adolescents suffer greater psychological impact preoperatively (P = 0.02) and have no difference in satisfaction (P = 0.47) or complication rates (P = 0.33) than normal-weighted patients. We conclude that obesity should not be used as an absolute contraindication to gynecomastia surgery.