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Gynecomastia Type 3

Type 3 Gynecomastia - Slight Breast Roll

1. Overview

  • Average cost: $9,000 -$10,000
  • Recovery 2 – 3 days sedentary work, 4-6 weeks heavy labor

2. Cruise Classification

  • Accurate assessment is critical to achieve your goals

3. Anatomy of Type 3

  • Firm, white, glandular tissue located almost exclusively underneath the nipple/areola

4. Optimal Results

  • The 8 components that define a masculine chest

5. Surgical Treatment

  • Best treatment options: Inferior crescent and Superior crescent

6. Recovery Timeline

  • Everything you need to know at a glance with progression pictures

7. Before & After Images

  • Type 3 before and after photos of Dr. Cruise’s patients

8. For Spouses & Parents

  • Eye opening insights of the unseen pain from those who have gone through it

Overview

Type 3 Overview

Slight Breast Roll

Definition

  • Breast tissue –extends over chest fold
  • Nipple position – 0 to 2 cm. below chest fold
  • Chest fold shape – moderate skin excess – horizontal chest fold (not rounded)
  • Most common demographic: 25 – 60 years old, single, married or married with children.
Characterized by the breast extending over the chest fold, which often times creates a slight breast roll.

Surgery Information

  • Anesthesia: Typically performed under local anesthesia in the office, however, general anesthesia is available as well.
  • Cost: Average cost under local anesthesia is $9,000 – $10,000. Cost will vary if combined w/ other procedures or performed under general anesthesia.
  • Consultation fee: Charged upon scheduling a consultation.
  • Recovery: 2 – 3 days for sedentary work, 4-6 weeks if the job requires heavy labor.

Cruise Classification System

Based on over 2500 gynecomastia surgeries, Dr. Cruise has classified gynecomastia into 6 different types. Each type is unique in its own way and must be treated differently. The purpose of the Cruise Classification System is to:
  • 1. Classify gynecomastia type
  • 2. Define patient goals
  • 3. Outline optimal treatment plan

A classification system is only useful if it outlines a treatment plan.

Dr. Cruise

Cruise Classification System – 6 Types of Gynecomastia

Notice the progressive increase in skin laxity. This excess skin will change the type of surgery necessary to properly correct the problem.

Breast tissue – under nipple/areola only

Nipple position – above border of pec. muscle

Lateral chest fold – tight, straight

Breast tissue – extends over chest fold

Nipple position – above border of pec. muscle

Lateral chest fold – tight, rounded

Breast tissue – extends over chest fold

Nipple position – 0 to 2 cm. below border of pec. muscle

Lateral chest fold – mild laxity, horizontal

Breast tissue – extends into axilla

Nipple position – >1.5 cm below border of pec. muscle

Lateral chest fold – small breast roll in front of arm pit

Breast tissue – extends into axilla

Nipple position – ≥ 2 cm below border of pec. muscle

Lateral chest fold – breast roll extends to the back of arm pit

Breast tissue – extends into axilla

Nipple position – ≥ 2cm below border of pec. muscle

Lateral chest fold – breast roll extends around to back

What is Type 3 Gynecomastia?

Type 3 Gynecomastia has similar breast tissue draping over the pectoralis muscle as Type 2. The difference is that the skin has relaxed and is no longer able to compress the tissue into a tight, rounded appearance. Instead it takes on a horizontal appearance.

Anatomy of Type 3 Gynecomastia

Nipple is at or below the pectoralis border but exact position is not easy to determine because muscle border is blurred by breast tissue. Nipple descent represents moderate skin laxity which shows itself as a horizontal chest fold instead of rounded. The skin is no longer tight enough to wrap around the muscle border.
This image demonstrates well how the breast tissue drapes over and blurs the pectoralis muscle border. The amount on the chest in type 3 is usually similar to type 2 but there is usually more tissue that extends into arm pit area. Removing this is critical to define the muscle.

Optimal Results for Type 3

Unfortunately, the clinical definition for optimal results is virtually non-existent; even in plastic surgery literature. This is why it was essential for Dr. Cruise to include it as part of the Cruise Classification System. A classification system is only useful if it identifies where you are and where you need to go. The first part of the classification system identifies 6 basic types based on where you are. This part of the system identifies where you need to go. It is true, different men have different goals. However, Dr. Cruise’s has identified eight fundamental aspects of the male upper chest that need to be evaluated in order to achieve a masculine chest. These eight components are outlined below.
Optimal results for Type 3 primarily involve 1-4 and to a lesser extent 5 and 6. Addressing these aspects determines your surgical road map. Proper evaluation is particularly true for Type 3 gynecomastia as these are the patients that are just beginning to show moderate skin laxity.

“Achieving optimal results and avoiding complications requires both expertise and a plan”

Dr. Cruise

Anatomy of a Masculine Chest

External view of masculine chest
Internal view of masculine chest

What defines “Optimal Results?”

The Cruise classification accurately defines “where you are”. Now, we need to clearly define in surgical terms “where you want to go.”
With this is mind, we asked Dr. Cruise to outline the most important aspects that need to be addressed when surgically treating gynecomastia and what they should ideally look like.

Eight Components

Overall, a masculine chest is full and powerful above the nipple but ripped and defined below. The key is to create muscle definition, flatten the nipple, yet keep the chest area above the areola normal thickness. Thinning too much will create a “fragile” appearance and worse, may create contour irregularities. The goal is to flatten the chest so that you can confidently wear tight white T-shirts and to create a V shape from both the back and front view.
Ideally, the nipple should be 1-2 cm above the pec. border (pectoralis major muscle). However, it is perfectly acceptable even if it is located directly on the border as long as it sits on a convex (not concave) surface. This is particularly true with body builders or men with large pec. muscles as it gives the low lying nipple a bigger base to sit on. However, when it sits below the pec. border it begins to face downward or worse it falls into the chest fold which is concave. Sitting in the chest fold often gives the appearance of “cratering.”
The areola is the dark, pigmented skin around the nipple. Areola size is proportionate to chest size. Ideally, it should 25-35 mm and lay flush with the surrounding skin. However, slight elevation is common. Most people do not consciously realize it but areolas are usually wider than they are tall. A perfectly round areola is not ideal and an areola that is taller than it is wide may even appear unusual or “surgical”.
Ideally, the pectoralis major muscle should be defined and straight with the skin wrapping around it into a well defined chest fold and then into a defined arm pit hollow. Excess breast tissue, fat and/or saggy skin will blur this border and create a round, feminine appearance.
Should have sculpted appearance with a well define hollow at its apex. The borders of the pec. major in front and the latissimus dorsi in back should be well defined giving a V shape to the upper body. Excess fat/saggy skin can fill the arm pit creating an uncomfortable fullness in armpit and a saggy breast roll just below. Creating a sculpted axilla and a V shape appearance to the upper body is one of the most rewarding parts of gynecomastia surgery yet it is usually overlooked as not being part of the gynecomastia. It is important for your surgeon to understand that the goal of surgery is to create a V shaped, masculine chest and not just to remove breast tissue. I can not tell you have powerful the results are when you create a sculpted pec., lat. and arm pit. It is truly life changing.

Ideally, there should not be any fat pockets. There are three common fat pockets that need to be evaluated and removed if present:

  1. Pre-axillary fat – located just in front of the armpit.
  2. Axillary fat – located within the arm pit itself and
  3. Breast roll fat – located just below the arm pit and creates a fullness or breast roll. It blurs pec., arm pit and lateral definition and disrupts V shape and the upper body that defines masculinity.
Should not be present. Not applicable to Type 3.
Not applicable to Type 3

Surgical Treatment Options

Below you will find treatment options for Type 3 Gynecomastia, along with an explanation of how the result differs for each.

Shorter Incision vs Optimal Chest Shape

This is often the biggest struggle gynecomastia patients have. Type 3’s and Type 4’s are where incision choices make the biggest difference. Experience has shown time and time again that chest shape trumps incisions with rare exceptions. In addition, it is important to consider how you will look not only in 1-2 years but also in 1-2 decades and beyond. Any skin laxity now will be a real problem as you age while incisions will be little more than a faded memory. It is better to have time on your side.

Type 3 Incision Options

Inferior crescent
Superior & inferior crescent with short vertical
Inferior crescent excision means that a 1/4″ to 1/2″ crescent shaped piece of skin is removed just below the areola. This technique not only tightens the chest skin, but, more importantly, it pulls the areola tight similar to getting the wrinkles out of a bed sheet. This little maneuver has a large impact in getting rid of excess skin that has been stretched over time. It also flattens the lower chest skin mildly so that it better wraps around the pec. border improving definition. The incision is located low on the areola where it is very hard to see even early on.
The superior incision is used to slightly elevate the nipple to make sure it stays on the convex pec. border and does not migrate downward into the concave chest fold when the breast tissue is removed. If this occurs and it could create a “crater” appearance. This is very common with Type 3. While a super incision is good from a positional standpoint, it does create some additional tension on the incision which means it will take longer to fade. Overall, it is the optimal option for lower hanging nipples.
Dr. Cruise does not use a full circular incision around the border of the areola (a.k.a. donut incision, donut lift) because it can create a puckered looking nipple. With the superior and inferior incision there is a break/gap between them for the purpose of avoiding this issue. Crescent incisions, however, create skin margins that do not line up exactly. The side toward the areola will always be shorter than its counterpart. When sutured together this length mismatch will create mild bunching that takes a little longer to fade away than a linear incision. For that reason a third incision is introduced, a small vertical component that fades very well. It get’s rid of the mismatch and also tightens the skin horizontally.
Inferior crescent excision means that a 1/4″ to 1/2″ crescent shaped piece of skin is removed just below the areola. This technique not only tightens the chest skin, but, more importantly, it pulls the areola tight similar to getting the wrinkles out of a bed sheet. This little maneuver has a large impact in getting rid of excess skin that has been stretched over time. It also flattens the lower chest skin mildly so that it better wraps around the pec. border improving definition. The incision is located low on the areola where it is very hard to see even early on. The superior incision is used to slightly elevate the nipple to make sure it stays on the convex pec. border and does not migrate downward into the concave chest fold when the breast tissue is removed. If this occurs and it could create a “crater” appearance. This is very common with Type 3. While a super incision is good from a positional standpoint, it does create some additional tension on the incision which means it will take longer to fade. Overall, it is the optimal option for lower hanging nipples. Dr. Cruise does not use a full circular incision around the border of the areola (a.k.a. donut incision, donut lift) because it can create a puckered looking nipple. With the superior and inferior incision there is a break/gap between them for the purpose of avoiding this issue. Crescent incisions, however, create skin margins that do not line up exactly. The side toward the areola will always be shorter than its counterpart. When sutured together this length mismatch will create mild bunching that takes a little longer to fade away than a linear incision. For that reason a third incision is introduced, a small vertical component that fades very well. It get’s rid of the mismatch and also tightens the skin horizontally.

Recovery Timeline

Gaining a better understanding about what to expect will help you properly prepare, plan, and reduce stress.
Click the image below to view a complete timeline of the recovery process following Type 3 Gynecomastia.

Everything you need to know about your recovery

TYPE 3 GYNECOMASTIA

Surgical Recovery Timeline

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Gynecomastia Before & After Photos

View our gallery of before and after photos to see the results from Type 3 Gynecomastia surgery. Remember, each patient is unique and results will vary from patient to patient.

Type 3 Before & After Examples

Emotional Cost of Gynecomastia

The pain and suffering associated with gynecomastia is unlike any other condition in plastic surgery and perhaps in all of medicine. The range of its impact is stunning. Some men (usually older) can be relatively unaffected while others (usually the younger) can be completely devastated and even suicidal.
Unfortunately, because of the stigma associated with it, it is not always readily apparent what your loved one may be experiencing. In fact, the men or more commonly pubescent teenagers, who are most deeply affected go to great lengths to suffer alone. The Internet becomes the only one they can talk to. This dangerous combination of deep emotional pain and isolation makes them particularly vulnerable to exploitation. Exploitation that takes the form of the literally thousands of “miracle” cures that have no medical merit to the more nefarious types looking to take advantage of the the emotionally weak.

Patient Perspective – common feelings associated with patients who have Type 3 Gynecomastia

  • Becoming increasingly self-conscious 
  • Feels trapped, unable to live the life he wants
  • Spending more time learning about what can be done to get rid of his man boobs. 
  • May or may not discuss concerns with those in his life. 
  • Wide spectrum of outward expression from normal to:
    • Hunched neck and shoulders.
    • Downward gazing head/eyes.
    • Uncomfortable with eye contact
    • Becoming less active, less social
    • Feeling depressed
    • Self-worth continues to decline 
    • Negatively impacting relationships including those with family, spouse/significant other, children, friends, and co-workers.
    • Wardrobe is changing. Starting to wear more button down shirts or less fitted shirts.
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Before and Afters
Reviews

Spouse/Significant Other Perspective – signs of concern

  • Observe. Is your spouse/significant other avoiding outdoor/shirtless activities he use to love?
  • Does he refuse to take his shirt off at the pool/beach?
  • Is he becoming more reclusive/negative?
  • Does he avoid going to the gym or working out in general?
  • Or, is he obsessed with working out and dieting?
  • Do you notice him researching or purchasing “miracle” sure supplements on the Internet?
  • Is he wearing over-sized clothing? Routinely tugging his shirt away from his chest? Putting his hands on his hips to mask his chest?
  • Does he become embarrassed when you see him without his shirt on?
  • Is he embarrassed when you see him without his shirt on?
  • Is your sex life declining?

Schedule a Consultation

Gynecomastia surgery is a tangible next step to resolve your man boobs. Dr. Cruise has performed over 5,000 gynecomastia surgeries and is ready to see you for a consultation. Call us at (949) 373-4867 or fill out our online contact form and you will be contacted with the next steps!

Video Testimonals - a Partner & a Patient

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CRUISE PLASTIC SURGERY / LAGYNECOMASTIA Main Office

  • Joseph T. Cruise, M.D.
  • 2081 San Joaquin Hills Road
  • Newport Beach, CA 92660

LAGYNECOMASTIA - Administrative Office