Type 6 Overview
Breast Roll with Back Roll
Breast tissue - extends into the armpit and around the back
Nipple position - > 2 cm below the chest fold
Chest fold shape - significant skin excess, breast roll extends around to the back, severe breast sag, no definition.
Most common demographic - no defined age group, history of obesity, massive weight loss
Characterized by severe breast sag and breast tissue which extends into the arm pit and around the back creating a breast roll with back roll.
Anesthesia: Typically performed under general anesthesia.
Cost: Determined case by case. Variable factors will determine cost.
Recovery: 3 - 4 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 6 Gynecomastia?
Type 6 Gynecomastia, by definition, has so much excess skin that it creates a breast roll that extend onto the back creating a "back roll". Like type 5 there is usually excess skin in "two directions". (See type 5). Proper treatment requires addressing both the excess tissue and excess skin in all directions. This is necessary to not only create a defined chest and sculpted arm pit, but to create a long term V shape to the upper body.
Anatomy of Type 6 Gynecomastia
Typical external appearance
What's going on underneath
Optimal Results for Type 6
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. However, with Type 6 patients it is critical to achieve the absolute best long term result possible. 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 are outlined below.
Anatomy of a Masculine Chest
External view of optimal result
Inside view of optimal result
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 find Dr. Cruise's preferred incision placement for effectively treating Type 6 Gynecomastia.
Type 6 Incisions - Upper Body Lift
Chest lift with nipple re-positioning (pedicle) or free nipple graft. Incision is positioned strategically within the natural chest fold.
Shows the extended incision rising in straight line across the axilla onto the back. Arm pit incision represents axillary. This bi-directional incision arrangement allows skin tightening in all directions.
Incision goes as far a the back roll goes. This may or may not require a circumferential incision (This is represented by dotted line.)
Type 6 Gynecomastia patients have massive amounts of excess skin in multiple directions. Optimal correction requires removing all the excess skin and re-positioning the nipple on top of the pec. major muscle where it belongs. The incisions on the chest are similar to the Type 5 chest lift. The circular nipple/areola incision routinely heals exceptionally well because it is not under tension. The chest fold incision is well hidden in the chest fold before it circles around to the back. This is the incision that takes the longest to fade; usually 1-2 years. This incision may go completely around the back or it may end over the scapula depending on if there is excess skin in the mid-line back.
Nipple Re-Positioning or Free Nipple Graft vs Anchor Lift
In short, for the vast majority of patients, the Nipple Re-Positioning or Free Nipple Graft is a significantly better procedure than the traditional Anchor Lift. The 4 main reasons are;
- The incision around the areola routinely becomes unnoticeable with the free nipple graft,
- There is no vertical incision below the areola,
- It reliably provides a flatter, more masculine result, and
- Contrary to what I initially thought, I have had far less complications.
Anchor Lift Incisions vs Free Nipple Graft Incisions
Nipple re-positioning/Free nipple graft
No vertical incision from areola to breast fold
Difference in Result
Anchor Lift & Nipple Re-positioning /Free Nipple Graft
After anchor lift
Notice the persistent breast fullness as well as skin sag that can not be corrected as well as with free nipple graft.
After nipple re-positioning/ free nipple graft
Notice that those incisions will typically provide a tighter and flatter chest than anchor lift with better scarring.
Gynecomastia Before & After Photos
View before and after photos to see the results of Type 6 Gynecomastia. Remember, each patient is unique and results will vary from patient to patient.
Type 6 Examples
Click the image below to view a complete timeline of the Type 6 gynecomastia recovery process. Gaining a better understanding about what to expect will help you properly prepare, plan, and reduce stress.
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 6 Gynecomastia:
- Frustrated massive weight loss left him with extremely saggy breasts. Not sure if the weight was worse or the breasts are worse.
- Still can't wear anything but baggy clothing.
- Wide spectrum of outward expression from normal to:
- Hunched neck and shoulders.
- Downward gazing head/eyes.
- Uncomfortable with eye contact.
- Trapped in a foreign body he doesn't recognize.
- Overwhelming feeling of helplessness.
- Self-image has hit rock bottom.
- Negative impact on other aspects of life including relationships, career motivation, health/exercise, social life.
Spouse/Significant Other Perspective - signs of concern
- Is he more reclusive/negative/depressed?
- Does he prefer not to be touched?
- Has he become too embarrassed to take his shirt off in front of you?
- Does he avoid physical contact and/or intimacy?