Joseph T. Cruise, M.D.
EXCELLENCE IN GYNECOMASTIA SURGERY

LOS ANGELES | BEVERLY HILLS | NEWPORT BEACH
(323) 987-4467 

 Gynecomastia Types

The purpose of categorizing the different gynecomastia types is to determine which treatment is best based on the underlying problem. Dr. Cruise has created the "Cruise Classification System" to demonstrate how each of the 6 gynecomastia types vary. Click below to see a detailed explanation and outline of treatment options for each type of gynecomastia.

"Classification system is only useful if it guides treatment." Dr. Cruise

 

 

Cruise Classification System – 6 Types of Gynecomastia

Gynecomastia Types

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

Type 1

Breast tissue - under nipple/areola only

Nipple position - above border of pec. muscle

Lateral chest fold - tight, straight

Type 2

Breast tissue - extends over chest fold

Nipple position - above border of pec. muscle

Lateral chest fold - tight, rounded

Type 3

Breast tissue - extends over chest fold

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

Lateral chest fold - mild laxity, horizontal

Type 4

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

Type 5

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

Type 6

Breast tissue – extends into axilla

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

Lateral chest fold - breast roll extends around to back

Shorter Incision vs Optimal chest shape

This is without doubt the biggest struggle gynecomastia patients have. However, it really only applies to patients with Gynecomastia Types 3 or 4.

Patients with Gynecomastia Types 1 and 2 do not have much to worry about as their skin is already tight. Their incision will be limited to around the areola. There are some Type 1's and 2's that have very low nipples. In these patients, nipple elevation is usually required to prevent the nipple from "falling off the pectoralis border". If this happens, the nipple is falls into the chest fold and it looks like it is "cratered". Clearly, not desirable. This requires a superior areola incision which is slightly more visible but still not an issue.

Gynecomastia Types 5 and 6 are discussed in their section. But suffice to say, incisions are unavoidable and are what make these results so spectacular.

Type 3's and Type 4's are where incision choices make the biggest difference. This decision process is discussed in those sections. However, 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 2-3 years but also in 2-3 decades. Any skin laxity now will be a real problem as you age while incisions will be nothing but a faded memory. It is better to have time on your side.

“With time, incisions fade while saggy skin gets worse” Dr. Cruise

Having said that, shorter incisions should be considered on patients who have a significant risk of very poor scarring. This includes history of true keloids and skin that hyper-pigments significantly. This needs to be discussed on a case by case basis taking into account patient goals.