- The Cruise Classification system for gynecomastia is designed to determine the optimal treatment based on type.
- The most challenging part of gynecomastia surgery is matching the “Rug Size” to the “Floor Size”
- The single most useful test to determine gynecomastia type is Chest Fold Angle
- Next, factor in the 3 most important gynecomastia type modifiers: Breast Tissue Size, Pec. Major Size and Skin Elasticity
- Final surgical adjustments are determined by the amount of Chest Fold Sag and Nipple Sag.
- Finally, Liposuction of the Axilla and Breast Roll are evaluated to bring proper proportion to the entire upper body.
- Follow Dr. Cruise’s step-by-step approach. For greater detail click the link to the actual exam.
- It is essential to understand that gynecomastia is a progression over time based on the weight of the breast tissue and strengh of the skin holding it.
- Over time, weight stretches skin.
- Stretching of skin is the primarily cause of progressing from a easy to correct type 1 and 2 to a more challenging type 3 and 4.
- Chest fold angle is single most useful measurement to determine skin excess – a.k.a. Rug Size.
- Type 1 is usually less the 45 degrees.
- Type 2 is usually 45 – 60 degrees.
- Type 3 is usually 60 – 90 degrees.
- Type 4 is usually greater than 90 degrees.
- It makes sense that removing more breast tissue would cause more deflation much like a grape to a raisin.
- In type 1 or type 2 patients it does not make as much difference as they do not have much skin excess and they usually have good skin elasticity to contract back.
- However, in type 3 patients it makes a huge difference and will change the type of surgery.
- The Pectoralis Major Size is what makes up the entire chest “Floor” when all the breast tissue is removed.
- Thus, pec. major size must be considered when deciding on how much breast tissue is removed.
- This is far and away most significant with type 3 patients.
- Now that the “Rug Size” and “Floor Size” have been determined, the next critical determination is how much will the skin contractl.
- Will the skin contract like a rubber band.
- Or Deflate like a balloon.
- This is where gynecomastia expertise is essential.
- Men over 40 years of age or have lost more that 40 -50 lbs have skin that is less likely to contract considerably.
- Only gynecomastia type 1 patients have a chest fold that is intact.
- This means that the weight of the breast tissue has not yet broken through the Chest Fold ligament and fallen off the Pec. major muscle and onto the upper abdomen.
- This is what causes Chest Rounding.
- Weakening of the Chest Fold ligament is what separates type 1 patients from tye 2.
- Many gynecomastia patients do not realize that the weight of the breast tissue will pull on the breast ducts which, in turn, will pull the nipple down.
- Nipple sag is not always obvious for the simple reason that there is also usually breast tissue sag.
- The concomitant descent of both the nipple and breast tissue makes the nipple appear as if it is in good location.
- However, when the breast tissue is removed it becomes apparent that the nipple has fallen into the chest fold.
- Nipples falling into the chest fold is the #1 cause of “Cratering”
- Thus, it is essential to know nipple position ahead of the procedure and have a plan. See Treatment section.