Gynecomastia (enlarged male breasts) does not occur similarly among all male teenagers and adults. there are certain factors that may differentiate one case from another. Not only does the size of breast enlargement vary, but so does the make-up of what is causing it and the quality of the skin.
The American Society of Plastic Surgeons classifies gynecomastia into 4 grades. 1 is the mildest and 4 the most severe.
Grade 1 – Very Mild
The breast typically has a localized area of tissue behind the areola. Frequently referred to as “puffy nipple.” Skin quality is generally very good. In most cases, only excess glandular tissue is present.
Grade 2- Mild to High
Moderate breast enlargement that goes beyond the areola with indistinct borders from the chest area. May consist of fatty tissue, glandular tissue or a combination of both.
Grade 3 – High and Visible
The same as moderate breast enlargement, but skin redundancy is also present. May consist of fatty tissue, glandular tissue or both.
Grade 4 – Severe and Feminized
Breasts look feminine with significant enlargement and skin laxity. May look maternal. Most often seen in aging men when skin quality worsens causing the breasts to look worse than they did when the skin was taut.
Gynecomastia is also classified based on symmetry. Not all men have gynecomastia in both breasts. Gynecomastia is identified as either bilateral or unilateral. Men with bilateral gynecomastia have an enlargement in both breasts, while unilateral gynecomastia means it is only present in one breast.
Classifying True Gynecomastia vs. Pseudogynecomastia
Understanding what is causing the enlarged breasts will determine the type of treatment needed.
True gynecomastia refers to enlarged male breasts caused by excess breast tissue. With Pseudogynecomastia the culprit is fat, not glandular breast tissue. Men who are obese or overweight are prone to pseudo-gynecomastia.
A physical examination by a board-certified plastic surgeon who specializes in gynecomastia is necessary to determine the type of gynecomastia you have and what the best treatment is for permanent correction. All too often, inexperienced surgeons defer to liposuction for treatment because it is the easiest to perform. Liposuction alone will only get rid of fat, it will not address glandular tissue or skin laxity. In many cases, a man’s gynecomastia may look worse after surgery if liposuction alone is performed when the culprit is not just fat.
Dr. Joseph Cruise, a world-renowned gynecomastia surgeon, has expanded on the classification system offered by the American Society of Plastic Surgeons. He created what he calls the “Cruise Classification System,” which consists of 6 types of gynecomastia along with the recommended treatment for each. The main difference between each comes down to the degree of skin laxity.
Understanding what type of gynecomastia you have will help you understand what type of treatment is best. Permanent correction of gynecomastia is possible when performed correctly. Be sure you seek out a highly qualified board-certified plastic surgeon who routinely performs gynecomastia surgery with good results.