Type 5 Overview
Significant Breast Roll
Breast tissue - extends into axilla
Nipple position - ≥ 2 cm below chest fold
Chest fold shape - significant skin excess, breast roll extends to back of arm pit
Most common demographic - overweight, massive weight loss
Characterized by droopy breasts with extra skin that extends into the armpit. A significant breast roll is usually present.
Anesthesia: Varies. Can be performed under local anesthesia in the office or general anesthesia in an accredited outpatient facility. Recommendation will be made by Dr. Cruise during the consultation.
Cost: Average cost $7,500 - $10,500. Cost will vary if combined w/ other procedures or performed under general anesthesia.
Recovery: 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 5 Gynecomastia?
Type 5 gynecomastia, by definition, has significant excess skin that creates a breast roll that goes beyond chest wall to the back of arm pit. Proper assessment requires taking into account skin deflation from removal of gynecomastia/fatty tissue. However, the major difference between types 4 and 5 is goes much deeper. Type 5 will have excess skin in "two directions." This means that in addition to excess skin in up and down direction, it also has excess skin in side to side direction. Tightening skin in both directions in addition to removing fat and sculpting arm pit is often required to achieve optimal long term, masculine chest results.
Anatomy of Type 5 Gynecomastia
Optimal Results for Type 5
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 a masculine chest. They are outlined below.
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.
Anatomy of a Masculine Chest
External view of masculine chest
Inside view of masculine chest
Surgical Treatment Options
The diagram below outlines Dr. Cruise's preferred incision method for treating Type 5 Gynecomastia. A detailed description about this method follows.
Shorter Incision vs Optimal Chest Shape
The chest should have a sculpted appearance with a well defined hollow at its apex. The borders of the pec. major in front and the latissimus dorsi in back should be well defined giving a V shape to the upper body. Excess fat/saggy skin can fill the arm pit creating an uncomfortable fullness in armpit and a saggy breast roll just below. For types 5 and 6’s, this is often as big of a concern as the chest. Creating a sculpted axilla and a V shape appearance to the upper body is one of the most rewarding parts of gynecomastia surgery yet it is usually overlooked as not being part of the gynecomastia. It is important for your surgeon to understand that the goal of surgery is to create a V shaped, masculine chest and not just to remove breast tissue. While this is true for all types it is particularly relevant for types 4,5 and 6. The results are powerful when a sculpted pec., lat. and arm pit are created. It is truly life changing.
Type 5 Gynecomastia Incisions - Extended Chest Lift
Chest Tightening with either:
Nipple Re-positioning (Pedicle) or Free Nipple Graft with Axillary Pleat.
Incisions look the same. The procedure is different.
It involves removing the excess skin by leaving an incision directly in the chest fold which is well hidden. Distinctive from FNG the nipple never leaves the body. It maintains its own blood supply and nerve supply and is a much easier recovery. Its biggest limitation is if there is a significant amount of glandular tissue.
The Axillary pleat incision is very well hidden within the arm pit region.
Advantages of the Extended Chest Lift with Axillary pleat compared to the Standard Chest lift:
- Skin tightening is much more dramatic and allows for arm pit sculpting. A result that will last the rest of your life.
- Fat removal is more aggressive and, thus, creates a more defined result
Type 5 Gynecomastia has a significant amount of excess skin that extends to the back of the arm pit region and often contains fat pockets. Surgical correction requires a chest lift with with either nipple re-positioning or free nipple graft to tighten the chest skin and re-position the nipple to it's ideal location. It also requires an extended incision with axillary pleat to tighten the armpit skin in two directions to achieve the desired sculpted masculine look.
Click the image below to view a complete timeline of the recovery process for Type 5 Gynecomastia surgery. Gaining a better understand 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 possible from Type 5 Gynecomastia surgery. Remember, each person is unique and results will vary from patient to patient.
Type 5 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 5 Gynecomastia:
- Hopeless, beyond frustrated.
- Feels like it never ends.
- Trapped in an alien body with no way out. Doesn't represent who they are inside.
- Emotional toll prevents making new relationships.
- Wide spectrum of outward expression from normal to:
- Hunched neck and shoulders.
- Downward gazing head/eyes.
- Worthless, abnormal.
- Wants to give up.
- Negative impact on almost all aspects of life; relationships, health/fitness, social life, career motivation, etc.
Spouse/Significant Other Perspective -signs of concern
- Is he too embarrassed to take his shirt off in front of you now?
- Is he becoming more depressed or negative?
- Is he gaining weight due to inactivity?
- Does his wardrobe consist of only baggy shirts?
- Is he uncomfortable with being intimate?