Firm, white, glandular tissue located almost exclusively underneath the nipple/areola
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
Anesthesia: Varies. Can be performed under local anesthesia in the office or general anesthesia in an accredited outpatient facility. A recommendation will be made by Dr. Cruise during the consultation.
Cost: Average cost $13,000 – $16,000. Cost will vary if combined w/ other procedures or performed under general anesthesia.
Consultation fee: Charged upon scheduling a consultation.
Recovery: 3 days for sedentary work, 4-6 weeks if job requires heavy labor.
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:
“A classification system is only useful if it outlines a treatment plan.” – Dr. Cruise
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.
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.
External view of masculine chest
Inside view of masculine chest
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.
The diagram below outlines Dr. Cruise’s preferred incision method for treating Type 5 Gynecomastia. A detailed description about this method follows.
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.
Chest Tightening with either:
Nipple Re-positioning (Pedicle) or Free Nipple Graft with Axillary Pleat.
Incisions look the same. The procedure is different.
Also referred to as Pedicle Gynecomastia. This is the most predictable way to create a youthful chest that will last virtually forever.
It involves removing the excess skin by leaving a well-hidden incision directly in the chest fold 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 armpit region.
Advantages of the Extended Chest Lift with Axillary pleat compared to the Standard Chest lift:
The best option for Type 5 requires a chest lift incision that removes a swath of skin from the medial chest into the armpit. It also re-positions the nipple/areola exactly where you want it with exactly the chest thickness you want. While this may seem like a long incision, it is actually very well hidden with time as it falls into the nature chest fold crease. When placed correctly, the incision replaces the rounded, feminine shape of the chest to one that is straight, well defined, and follows the margin of the pec. major muscle creating a much more masculine look.
Well over 500 cases have shown that there is little regret going with this incision because its dramatic, youthful improvement of chest shape far out-weighs the incision; even in patients that tend to keloid. While on the other hand, patients have regretted going with a smaller procedure and not tightening the skin more.
The three significant advantages of this procedure are:
A free nipple graft means that the nipple and areola are repositioned as a skin graft. This requires 2 weeks of wearing a vest 24/7.
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.
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.
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.
Gynecomastia surgery is a next step that many men choose to resolve their gynecomastia (man boobs). Give our office a call at (949) 644-4808 or fill out our online contact form to get more information on gynecomastia surgery. Dr. Cruise also offers consultations to hear about your gynecomastia journey thus far.