Type 4 Overview
Moderate Breast Roll
Breast tissue - extends into the axilla (armpit area)
Nipple position - > 2 cm below the chest fold
Chest fold shape - significant skin excess - creates a small breast roll
Most common demographic: 40 - 60 years old, aging male, married or married with children.
Type 4 is characterized by the breast drooping and nipple falling 2 cm or more below the chest fold. There is usually a breast roll present.
Anesthesia: Varies. Local anesthesia in the office or general anesthesia performed at an accredited outpatient facility.
Cost: Average cost $6,900 - $9,500 depending on whether surgery is performed under local or general anesthesia. Cost will also increase if combined w/ other procedures.
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." - Dr. Cruise
What is Type 4 Gynecomastia?
Type 4 Gynecomastia has breast tissue that extends into arm pit region similar to type 3. The major difference is that there is significant excess skin that causes the horizontal chest fold to extend into arm pit creating a breast roll. Proper assessment requires that you take into consideration that removing the gynecomastia tissue will cause "deflation". Evaluation requires knowing how much skin will be present after tissue removal. Tightening this skin is often required to achieve long term, masculine chest results.
Anatomy of Type 4 Gyencomastia
Optimal Results for Type 4
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 next part of the system identifies where you need to go. It is true, different men have different goals. This is particularly true with Type 4 Gynecomastia. However, Dr. Cruise's has identified eight fundamental aspects of the male upper chest that need to be evaluated in order to achieve optimal results. Page down to see the eight components that define a masculine chest.
Masculine Chest Visualized
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
See below for Dr. Cruise's preferred incision options for treating Type 4 Gynecomastia.
Shorter Incision vs Masculine Chest Shape
Type 4 Gynecomastia patients are often in good physical shape but have significant excess chest and arm pit skin laxity. This physical condition allows them the opportunity for a youthful, masculine chest that they can be proud of.
While type 5 and 6 patients have significant issues that need to be overcome, Type 4 typically just requires proper nipple placement and a tight skin envelop. As one of the top gynecomastia surgeons in the U.S., Dr. Cruise uses his expertise to create a sculpted arm pit with a well defined hollow at its apex. He then flanks the areas to define borders of the pec. major in front and the latissimus dorsi in back. This not only shapes the chest but gives a powerful, well defined V shape to the upper body. Typically, this can only be achieved with the longer, chest lift incision as opposed to the shorter super extended superior incision. The techniques explained here are likely not practiced by doctors who perform just a few male breast reduction surgeries per year. A great deal of knowledge, skill, and experience is necessary to properly execute this type of surgical plan.
Type 4 Gynecomastia Incision Options
Chest Tightening with One of the Following:
- Nipple Repositioning (Pedicle), or
- Free nipple graft
It involves removing excess skin by leaving a well hidden incision directly in the chest fold. The nipple never leaves the body, maintaining its own blood and nerve supply. This makes for a much easier recovery. Its biggest limitation is with significant amounts of glandular tissue.
Click the image below to view a complete timeline of the recovery process following Type 4 Gynecomastia surgery. Gaining a better understanding of what to expect will help you prepare, plan, and reduce stress.
Gynecomastia Before & After Photos
View our gallery of before and after photos to see the results from Type 4 Gynecomastia surgery. Remember each patient is unique and results will vary from person to person.
Type 4 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 4 Gynecomastia:
- Having lived with gynecomastia for quite some time, it appears much worse now.
- More self-conscious about his chest then signs of aging showing on his face.
- Feels hopeless.
- Likely knows about "gynecomastia," but has avoided pursing options for getting rid of it. Frustration with the changes in his chest due to aging are a big reason for considering doing something now.
- Hunched neck and shoulders
- Hands on hip, always pulling shirt off chest
- Downward gazing head/eyes.
- Uncomfortable with eye contact
- Will not take his shirt off in public
- Depressed, hopeless.
- Avoids interaction with young children
- Wears baggy, old-man clothing
Spouse/Significant Other Perspective - signs of concern
- Observe. Are the behaviors above becoming worse?
- Have activities become almost non-existent?
- Is working out or dieting a thing of the past?
- Has he purchased compression garments to wear under his shirts hoping to hide his chest?
- Is he embarrassed when you see him without his shirt on?
- Does he avoid hugging?
- Is your sex life declining?
- Does he act hopeless, depressed or moody?