Type 3 Overview
Slight Breast Roll
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.
Anesthesia: Typically performed under local anesthesia in the office, however general anesthesia is available as well.
Cost: Average cost under local anesthesia is $6,900 - $7,500. 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 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:
- Classify gynecomastia type
- Define patient goals
- Outline optimal treatment plan
"A classification system is only useful if it outlines a treatment plan."
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.
Masculine Chest Visualized
External view of masculine chest
Inside view of masculine chest
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.
What's going on underneath
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.
Anatomy of a Masculine Chest
External view of masculine chest
Inside 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.
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 Incisions
The most common incisions for Type 3 gynecomastia is a combination of the inferior and superior 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 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. However, it is certainly worth it.
Click the image below to view a complete timeline of the recovery process following Type 3 Gynecomastia. 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 3 Gynecomastia surgery. Remember, each patient is unique and results will vary from patient to patient.
Type 3 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 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.
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?