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What You Should Know About Gynecomastia: Type 4

October 7, 2021

Dr. Joseph Cruise has extensive experience treating gynecomastia and is regarded as one of the top surgeons in the world. This led him to create the Cruise Classification system to further define six distinct types of gynecomastia and the best surgical plan to treat each type. If you are a regular reader of our blog, you are already familiar with gynecomastia types 1-3. Here, we will take a closer look at Type 4 gynecomastia, or “moderate breast roll” gynecomastia, and the best treatment plan to restore a masculine-looking chest. 

What is Type 4 Gynecomastia?

Type 4 gynecomastia is defined by excess breast tissue in men with the addition of skin laxity and typically fatty tissue. It also frequently consists of a breast roll. Type 4 gynecomastia patients will see moderate to significant excess skin that causes a small roll that extends into the armpit area. The excess drooping skin is the primary difference between type 3 and type 4, causing the noticeable sagging and breast roll. Typically, the breast shape will droop, and the nipples will fall two centimeters or more below the chest fold. The typical Type 4 gynecomastia patient is between 40 and 60 years old, but younger men may experience this as well. 

What Causes Type 4 Gynecomastia?

Like other types of gynecomastia, Type 4 can be caused by factors like side effects of drugs like steroids, genetics, or hormonal imbalance. Because this type of gynecomastia is more likely to affect middle-aged and older men, aging, weight gain or hormone imbalance can be the cause. In addition, the drooping or sagging skin is a significant factor in this type of gynecomastia. In fact, some Type 4 patients may have sagging skin alone rather than true gynecomastia. This can be caused by the normal collagen and elastin loss in the skin that takes place as you age, resulting in poor skin elasticity. Another factor may be weight loss, with loose and excess skin causing the breast roll appearance rather than following the contour of the patient’s slimmer body.

 How is Type 4 Gynecomastia Treated?

The primary concern in Type 4 gynecomastia patients is addressing skin laxity. As such, Dr. Cruise focuses on removing breast tissue, fatty tissue, excess skin and replacing the nipple to a more natural and flattering position higher on the chest. He sculpts the armpit and chest shape by carefully removing skin and other tissues from the area as needed to create a more masculine look. The areola and nipple are also surgically repositioned. Unlike Types 1-3, this surgery must be completed using longer incisions for the best possible results. In this video, Dr. Cruise outlines the typical incision shapes and surgical plan for a Type 4 gynecomastia patient.

After surgery, most Type 4 gynecomastia patients will require about one week of downtime to rest and recover, and up to 2-3 weeks if their job is physically strenuous. During this time, it is expected to experience swelling, redness, and some discomfort that can be relieved with pain medication as prescribed by Dr. Cruise. During your consultation, Dr. Cruise can answer any questions you may have about the surgery or recovery period.

Schedule a Consultation

Dr. Cruise is a leader in gynecomastia surgery, having personally developed the classification system that differentiates types of gynecomastia and their best treatment options. To schedule a consultation with Dr. Cruise, call our Newport Beach, CA office at (949) 644-4808 or contact us online. Out-of-town and busy patients can also complete our virtual fast-track consultation. 

Plastic Surgeon | Website | + posts

Dr. Joseph Cruise is a board-certified plastic surgeon with over 20 years of experience. Regarded as one of the top gynecomastia surgeons in the world, Dr. Cruise has gynecomastia-specific content that can be found at Dr. Cruise has dedicated his career to cosmetic surgery but has also had extensive training in General Surgery, Hand Surgery, and Microvascular Surgery. Dr. Joseph Cruise is also a member of the Rhinoplasty Society as well as the American Society of Plastic Surgeons.

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