Type 1 Overview
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 body builders
Characterized by a bulging, shiny areola and an over-projecting nipple.
Anesthesia: Typically performed under local anesthesia in the office, however general anesthesia is available as well.
Cost: Average cost under local anesthesia is $6,500. Cost will vary if combined w/ other procedures or performed under general anesthesia.
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 must be treated differently. The purpose of the Cruise Classification System is to:
- Classify gynecomastia type
- Define patient goals
- Outline optimal treatment plan
"A classification system is only useful if it outlines a treatment plan."
- Dr. Cruise
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 breast tissue extending over muscle border. This causes chest fold rounding.
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, glandular tissue located almost exclusively underneath the nipple/areola. This 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 necessary mean easiest. In fact, Puffy Nipple patients are very particular and do not tolerate complications such as persistent puffy nipple, cratering, contour irregularities, etc. Type 1 patients are typically in very good physical shape to begin. While puffy nipple is of the major concern, there are many other aspects of Type 1 that absolutely need to be addressed in order to not only achieve optimal result but, more importantly, avoid complications.
"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 answer is actually very difficult to find. Compared to other medical conditions, clinically relevant information is not available. This ignorance is unacceptable particularly because it has such significant impact on so many men’s lives. Even plastic surgeons are often vague as to what is the best way to evaluate and treat. 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.
Surgical Treatment Options
Incision visibility is less of an issue with Type 1 Gynecomastia - Puffy Nipples - 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 nipples 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 1'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 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.
Type 1 Incision Options
Most common Type 1 incision with Dr. Cruise. 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 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. 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. However, it is certainly worth it.
Click the image below to view a complete timeline of the recovery process following Type 1 Puffy Nipples Gynecomastia surgery. Gaining a better understanding about what to expect will help you properly prepare, plan, and reduce stress.
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
Human 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.
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
- Giving up
- 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.
Parent Perspective – signs of concern
How parents can help when they notice some or any of the concerns/signs below:
- Observe. Is your son avoiding outdoor/shirtless activities he use to love?
- Does he wear shirt at pool/beach?
- Is he more reclusive/negative?
- Does he decline in academics?
- Does he come up with excuses to avoid PE?
- More obvious – is he being ridiculed by schoolmates and even friends, being called titty twister, or being a subject of “man boobs” jokes, etc?
- 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 judgement free.
Spouse/Significant Other Perspective - signs of concern
- Observe. Is your spouse/significant other avoiding outdoor/shirtless activities he use to love?
- Does he wear shirt at the pool/beach?
- Is he more reclusive/negative?
- Does he avoid going to the gym or working out in general?
- Or, is he obsessed with working out and dieting?
- Is your sex life declining?
- Is he wearing over-sized clothing? Routinely tugging his shirt away from his chest?
- Does he become embarrassed when you see him without his shirt on?