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Gynecomastia Type 1

Type 1 Gynecomastia - Puffy Nipples

1. Overview

Average cost: $7,500 – $8,500
Recovery: 2 days for sedentary work, 4-6 weeks for heavy labor

2. Cruise Classification

An accurate assessment is critical to achieve your goals

3. Anatomy of Type 1

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, superior crescent or inferior linear

6. Recovery Timeline

Everything you need to know at a glance with progression pictures

7. Before & After Images

Type 1, puffy nipples 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

Type 1 Overview – Puffy Nipples


Breast tissue – located primarily beneath nipple/areola

Nipple position – at or above pectoralis

Chest fold shape – tight skin, straight chest fold with no rounding

Most common demographic: 15 – 25, teenagers and bodybuilders

Characterized by a bulging, shiny areola and an over-projecting nipple.

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 $7,500 – $8,500. Cost will vary if combined w/ other procedures or performed under general anesthesia.

Consultation fee: Charged upon scheduling a consultation.

Recovery: 2 days for sedentary work, 4-6 weeks if 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.

  • 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

What is Type 1 Gynecomastia?

Type 1 gynecomastia is more commonly referred to as puffy nipples. Patients with puffy nipples will have tight skin. This allows the skin to wrap around the pectoralis border in a straight line, because there is little or no breast tissue blurring the muscle definition. In contrast, Type 2 gynecomastia typically has a breast lump or fatty tissue extending over muscle border. This causes chest fold rounding. In addition to the visible nature of growing tissue, many people with mild to moderate breast tissue growth will experience breast tenderness.

Anatomy of Type 1 Gynecomastia

  • Type 1 appearance

    Characterized by puffy nipples. Patients are typically young, thin with a straight, well-defined pectoralis muscle

  • What is going on underneath?

    Notice the firm, white, breast glands located almost exclusively underneath the nipple/areola. This excess fatty tissue is what creates puffy nipples.

Optimal Results for Type 1

Unfortunately, the clinical definition for optimal results for gynecomastia is virtually non-existent; even in plastic surgery literature. Type 1 does not necessarily mean easiest to treat, although it is defined as the most mild amount of breast tissue growth.

In fact, puffy nipple patients are very particular and do not tolerate delicate complications such as persistent puffy nipple, cratering, contour irregularities, etc. Type 1 patients are typically in very good physical shape to begin with. While puffy nipple is the major concern, there are many other aspects of Type 1 male breast growth that absolutely need to be addressed in order to not only achieve an optimal result but, more importantly, avoid complications.

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

– Dr. Cruise

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    The most common cause of poor outcomes is not having this plan. Unfortunately, gynecomastia treatment has never been given the same attention that most other plastic surgery procedures. This over-sight is the reason for this site. To create the fertile infrastructure to allow both patients and surgeons to communicate their experience. To exchange ideas and show not only what works but also what doesn’t.



Anatomy of a Masculine Chest

External view of masculine chest

Internal view of masculine chest

What defines “Optimal Results” For Reducing Enlarged Breasts?

This question is actually very difficult to answer from a medical perspective. Compared to other medical conditions, clinically relevant information is not available for treating breast gland tissue in one or both breasts. This ignorance is unacceptable particularly because it has such a significant impact on so many men’s lives. Even plastic surgeons who diagnose gynecomastia are often vague as to what is the best way to evaluate and treat it.

To simplify this, Dr. Cruise outlines the 8 areas of the upper body that need to be considered to provide a surgical road map that will predictably achieve your optimal results.

Eight Components

Surgical Treatment Options

Incision visibility is less of an issue when the gynecomastia diagnosed is mild Type 1 Gynecomastia compared to the other types. This is because even the most aggressive incision (the superior crescent) still remains within the “forgiving” areola compared to the less-forgiving non-areola skin. Puffy nipple surgical results typically leave no visible scarring.

Shorter Incision vs. Optimal Chest Shape

Type 1 patients do not have much to worry about extra incisions as their skin is already tight. Their incision will be limited to around the areola. There are some Type 1s 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 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.

Inferior Crescent Incision

Inferior crescent excision means that a 1/4″ to 1/2″ crescent-shaped piece of skin is removed just below the areola. This does several good things beyond tightening the chest skin. More importantly, it pulls the areola tight similar to getting the wrinkles out of a bedsheet.

This little maneuver has a large impact on 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.

Crescent incisions, however, create skin margins that do not line up exactly. The side toward the areola will always be shorter than its counterpart. Suturing together this length mismatch may create mild bunching that takes a little while to fade away.

Recovery Timeline


Surgical Recovery Timeline


Gynecomastia Before & After Photos

View our gallery of before and after photos to see the results from Type 1, Puffy Nipples, Gynecomastia surgery. Remember, each patient is unique and results will vary from person to person

Type 1 - Puffy Nipples 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.

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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.

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Patient Perspective – common feelings associated with patients who have Type 1 Gynecomastia:

  • Trapped and alone during critical formation of self-worth period.
  • Feels as if he is only one with problem.
  • Unaware condition has a name: Gynecomastia. (However, internet is changing this).
  • May or may not discuss concerns with parents.
  • High school is emotionally difficult enough; gynecomastia can be anywhere from uncomfortable to unbearable.
  • Wide spectrum of outward expression from normal to:
    • Hunched neck and shoulders.
    • Downward gazing head/eyes.
    • Uncomfortable with eye contact.
    • Becoming more and more reclusive for no obvious reason.
    • PE class is torture.
    • Feeling depressed.
    • Poor self-image.
    • Negative impact on other aspects of life including school, family, friends.





Insight from a patient

I felt embarrassed having an femininely shaped chest. I didn’t feel masculine and it caused me great anguish.

I avoided situations that required me to take my shirt off, like swimming. I would hunch my shoulders so that my shirt would drape over my chest, because I was afraid other people would notice my chest. 

A friend of mine told me I had man-boobs and I immediately realized that other people noticed what I had seen all along. I immediately felt embarrassed and wanted to disappear. 

I would wear loose fitting shirts and hunch my shoulders so that my chest wouldn’t protrude. I was unable to stick my chest out with pride (literally).

Try diet and exercise to see if you can reduce the appearance of your gynecomastia. If you’re still unhappy, research a competent surgeon. That’s the route I took and I was fortunate enough to find Dr. Cruise. 

I did pursue gynecomastia surgery and the only regret I have is that I did not do it sooner. I am so pleased with the results that I can not wait for the summer so I can walk along the beach with my shirt off. The boost to my confidence has been enormous. I totally believe it was worth it. The biggest impact I’ve seen (besides my confidence) is that I’m able to stand up straight again without worry about my “man-boobs” protruding. Something as simple as standing up straight not only makes me look more confident, but I feel more confident. 

Vincent, 25

Parent Perspective – signs of concern

How parents can help when they notice some or any of the concerns/signs below:

  1. Observe. Is your son avoiding outdoor/shirtless activities he use to love?
  2. Does he wear a shirt at the pool/beach?
  3. Is he more reclusive/negative?
  4. Has he declined in academics?
  5. Does he come up with excuses to avoid PE?
  6. More obvious – is he being ridiculed by schoolmates and even friends, being called titty twister, or being a subject of “man boobs” jokes, etc?
  7. Does he wear over-sized clothing? Routine tugging of shirt over chest?

Most of the time, your son will not want to “speak up” about his embarrassment of Gynecomastia. In addition, he probably does not even know there is a name for the condition that he suffers with. The key here is to educated the child on Gynecomastia. The best way is to first approach your child and ask them why he has not been going to the pool or avoiding shirtless situations. If you have a specific example, use it. Have this conversation in a private place where he has your full attention and feels safe to open up. Using media coverage such as the article in Parenting OC is a good way to break the ice. Some intro statements could be:

  • I noticed that you did not want to go swimming with your friends last week, I know how much you love to swim, so I just wanted to check in and make sure all is ok.
  • It seems like you have been not wanting to participate in activities that require you to be shirtless and I just wanted to let you know that if you are feeling self-conscious about an element of your body, I am here if you want to talk about it.
  • A lot of body changes can happen during the teen years and if anything is happening to your body that you are not comfortable with or embarrassed about, please let me know as I may be able to help you. I just read an article in Parenting OC about Gynecomastia and I thought it would be good for you to look it over to see if this is something you may be dealing with.

Very important: Let your child know that you are judgment-free.

Spouse/Significant Other Perspective – signs of concern

  1. Observe. Is your spouse/significant other avoiding outdoor/shirtless activities he use to love?
  2. Does he wear shirt at the pool/beach?
  3. Is he more reclusive/negative?
  4. Does he avoid going to the gym or working out in general?
  5. Or, is he obsessed with working out and dieting?
  6. Is your sex life declining?
  7. Is he wearing over-sized clothing? Routinely tugging his shirt away from his chest?
  8. Does he become embarrassed when you see him without his shirt on?

Schedule a Consultation

Gynecomastia surgery is a way to feel like the best version of yourself physically and mentally. Dr. Cruise has performed over 5,000 gynecomastia surgeries and is available to meet you for a consultation. Start by filling out our online contact form or call our office at (949) 644-4808.