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Types of Gynecomastia: Dr. Cruise’s Classification System

June 24, 2021

While many surgeons may offer gynecomastia surgery, few have the in-depth understanding of various types of gynecomastia and the techniques that best suit each one. Through extensive experience, Dr. Cruise has categorized six different types of gynecomastia along with his recommended surgical treatment for each type. Below are descriptions for each type outlined by gynecomastia expert Dr. Cruise.

Type 1 Gynecomastia: Puffy Nipple

For patients with type 1 gynecomastia, excess tissue is located directly beneath the nipple and areola, causing a “puffy” or over-projecting areola appearance. Often, the areola will also have a shiny appearance. This type of gynecomastia is most common among teenagers, thin men, and men and bodybuilders. Type 1 gynecomastia requires glandular tissue removal only which is done through a small happy face incision along the bottom margin of the areola. Scarring is very favorable in this area. Type 1 cases are performed in-office under local anesthesia unless the patient prefers general anesthesia or there is reason why this option would be more suitable.

Type 2 Gynecomastia: Rounded Chest

Type 2 gynecomastia is identified by breast tissue which extends beyond the area beneath the areola. The tissue essentially expands in varying degrees across the lower pec. The areolas are positioned on the pec and there is tight skin. There may or may not be rounding of the chest shape. Typically, type 2 gynecomastia consists of primarily glandular tissue removal through a crescent-shaped incision below the areola just as with Type 1. There may be the need for some added liposuction if there is any fatty tissue present or if mild skin tightening is needed to create a defined pec. Type 2 cases are almost always performed in-office under local anesthesia unless general anesthesia is requested or more suitable due to a medical or psychological issue. 

Type 3 Gynecomastia: Slight Breast Roll

Men with type 3 gynecomastia usually have breast tissue which extends past the chest fold and nipples that fall below the chest fold, with a mild to moderate amount of skin laxity. Some mild Type 3 cases will be treated like a Type 2 to avoid the need for additional incisions. Aggressive skin tightening may be needed to help the skin contract for an optimal result. Some Type 3 patients will need nipple repositioning which will require either crescent incisions at the top and bottom of the areola or fully around the areola. It is also common for Type 3 to need both glandular tissue and fatty tissue removal. Fatty tissue is most often present in the breast roll, lower breast pole, axilla and pre-axilla. Some Type 3 cases can be performed under local anesthesia, but this will be determined with Dr. Cruise at the time of consultation. 

Type 4 Gynecomastia: Moderate Breast Roll

In type 4 gynecomastia, patients have excess breast tissue which extends to the armpit area as well as significant excess skin, resulting in a notable breast roll. The nipple is likely to droop two centimeters or more below the chest fold. Type 4 gynecomastia almost always consists of excess glandular tissue with fatty tissue and skin laxity. Gynecomastia surgery for type 4 requires nipple repositioning so it sits in a natural position on top of the pec. Almost always there is also liposuction needed of the surrounding areas such as the breast roll, axilla and pre-axilla. General anesthesia is usually recommended, but in some cases local anesthesia may be an option as well. 

Type 5 Gynecomastia: Significant Breast Roll

Type 5 gynecomastia consists of glandular tissue, fatty tissue and skin excess. The breast toll usually extends to the axilla or armpit area. Loose skin will also be present, and the nipples generally fall below the chest fold by two or more centimeters. This type of gynecomastia is most common among men who are overweight or who have lost a significant amount of weight. To treat type 5 gynecomastia, Dr. Cruise will generally make incisions across the chest crease and in the axilla to tighten the skin and remove excess tissue. In addition, the nipples are repositioned by making incisions around the areola. Liposuction is also needed to address the excess fat surrounding the chest. Type 5 cases are performed under general anesthesia. 

Type 6 Gynecomastia: Breast Roll with Back Roll

With type 6 gynecomastia, men will see breast tissue which extends into the armpit and around to the back. The chest lacks any definition with severe sagging of the skin. The nipples will also fall two centimeters or more below the chest fold. Type 6 gynecomastia can affect men of any age, and is most common among those who have a history of obesity and have lost a significant amount of weight. Surgery to correct this type of gynecomastia typically combines gynecomastia surgery and upper body lift techniques, with incisions made across the chest fold, into the armpit, and around to the back. Through these incisions, excess tissue is removed to restore a masculine contour. The nipples are also repositioned using either a free nipple graft (incision around the areola) or an anchor lift. Type 6 cases are always performed under general anesthesia.

Schedule a Consultation

To learn more about which type of gynecomastia you have and the surgical plan to correct it,  we encourage you to schedule a consultation with an experienced professional. As one of only a handful of gynecomastia specialists in the world, Dr. Cruise is uniquely qualified to help. Schedule a consultation with Dr. Cruise in Newport Beach, CA by calling (949) 644-4808. Out-of-town patients can also complete a virtual 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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