Classification of Gynecomastia

There are many ways of classifying Gynecomastia.
It could be classified acording to which parts is enlarged : (1) True Gynecomastia – gland enlargement (2) False Gynecomastia – Over fat accumulation (3) Mixed Type – Both gland & fat over growth.

And, It could also be classified according to its time of onset & cause,

– Newborn gynecomastia

  • A physiological response to high levels of maternal and placental estrogen transferred in utero. A secretion sometimes called witch’s milk can often be expressed.

– Pubertal gynecomastia:

  • A physiological response to the increase in testosterone fueled by marked increases in GH, insulin-like growth factor-1, FSH, and LH at puberty
  • Estrogen increases 3-fold, but peaks earlier than testosterone.

– Adult gynecomastia (physiological):

  • A physiological response to the decrease in free testosterone and the increase in adipose tissue that often accompanies ageing
  • Testosterone is converted to oestrogen in adipose tissue.

– Adult gynecomastia (non-physiological):

  • A response to increased oestrogen effect relative to androgen effect from a cause other than ageing.

– Pseudo-gynecomastia:

  • Male breast enlargement entirely due to adipose tissue.

Grade of Gynecomastia

The chart below shows the grade of gynecomastia and it’s corresponding description. This grade is according to the American Society of Plastic Surgeons(ASPS).

Grade or Type Description Severity
1 A localized button of tissue that is concentrated around the areola Very mild
2 Moderate breast enlargement exceeding areola boundaries
with edges that are indistinct from the chest
Mild to high
3 Moderate breast enlargement exceeding areola boundaries
with edges that are distinct from the chest with skin redundancy present
High and visible
4 Marked breast enlargement with skin redundancy and feminization
of the breast
Severe and visibly feminine

Operation Method of Gynecomastia

The grading that we use, depend on the skin sagging.
It is just natural that our operation method would also depend on it.
The chart below give you an idea on what operation will be applicable for you.
It will be confirmed during face-to-face consultation.