Gynecomastia classification: Difference between revisions

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*There is no established system for the classification of [disease name].
*There is no established system for the classification of [disease name].
OR
OR
*[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
*[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4]
OR
OR
*[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].
*[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].

Revision as of 17:00, 7 August 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]

Overview

Gynecomastia can be classified on the basis of clinical appearance, etiology or histopathology.

Classification

  • There is no established system for the classification of [disease name].

OR

  • [Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4]

OR

  • [Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].
  • [Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].

OR

  • Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.

OR

  • If the staging system involves specific and characteristic findings and features:
  • According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].

OR

  • The staging of [malignancy name] is based on the [staging system].

OR

  • There is no established system for the staging of [malignancy name].
Author Year Method of classification Classification system
Nydick 1961 Physical appearance
  • Gland limited to the retro areolar region; it does not reach the edge of the areola.
  • Gland extends as far as the edge of the areola.
  • The increase in gland volume extends beyond the edge of the areola.
Tanner 1971 Physical appearance
  • Stage 1: Nipple prominence.
  • Stage 2: Mammillary button stage; the breast and the areola- nipple are slightly swollen and the diameter of the areola increases.
  • Stage 3: Further swelling of the breast and areola without separation of their edges.
  • Stage 4: Areola and nipple become protrusive and form a secondary protrusion above the breast.
  • Stage 5: There is protrusion of the nipple only after retraction of the areola from the breast surface.
Simon 1973 Physical appearance
  • GRADE 1: Small visible breast enlargement, no skin redundancy.
  • GRADE 2a: Moderate breast enlargement without skin redundancy.
  • GRADE 2b: Moderate breast enlargement with skin redundancy.
  • GRADE 3: Marked breast enlargement with marked skin redundancy.
Deutinger and Freilinger 1986 Physical appearance
  • Grade 1: Thoracic wall poor in the flesh; mammary tissue localized behind and around the nipple; no skin excess.
  • Grade 2: Adipose thoracic wall; widespread alterations; breasts similar to feminine ones during puberty.
  • Grade 3: Widespread alterations; excess adipose tissue, skin redundancy, inframammary fold and ptosis.
Cohen 1987 Physical appearance
  • Group 1: Glandular gynecomastia.
  • Group 2: Glandular gynecomastia with ptosis.
  • Group 2: Glandular gynecomastia with ptosis.
  • Group 3: Adipose gynecomastia.
  • Group:4 Adipose gynecomastia with a slight glandular component.
Rohrich 2003 Physical/Tissue type
  • GRADE 1: Minimal hypertrophy, (less than 250g of tissue) without ptosis
    • 1a: Primary glandular
    • 1b: Primarily fibrous
  • GRADE 2: moderate hypertrophy (250-500g of breast tissue) without ptosis
    • 2a: Primarily glandular
    • 2b: primarily fibrous
  • GRADE 3: Severe hypertrophy (>500g of breast tissue with grade 1 ptosis glandular or fibrous
  • GRADE 4: Severe hypertrophy with grade 1 or 3 ptosis glandular or fibrous
Gusenoff 2008 Physical
  • GRADE 1: Minimal excess skin and fat, minimal alteration of NAC, normal IMF
    • 1a: No lateral skin roll
    • 1b: Lateral skin roll Grade
    • 2: NAC and IMF below the ideal IMF, lateral chest roll, minimal upper abdominal laxity
  • GRADE 3: NAC and IMF below the ideal IMF, lateral chest roll, significant upper abdominal laxity.
Barros 2012 Physical
  • GRADE I: Increased diameter and slight protrusion limited to the areola region
  • GRADE II: Moderate hypertrophy of the breast with the NAC above the IMF
  • GRADE III: Major hypertrophy of the breast with glandular ptosis and the NAC situated at the same height as or as much as 1 cm below the IMF Grade IV: Major breast hypertrophy with skin redundancy, severe ptosis, and the NAC positioned ≥1 cm below the IMF
Çi̇l 2012 Imaging (computed tomography Gynecomastic adipose tissue/total gynecomastic tissue, <0.3 Gynecomastic adipose tissue/total gynecomastic tissue, 0.3–0.5 Gynecomastic adipose tissue/total gynecomastic tissue, >0.6
Cordova 2008 Physical
  • GRADE I: Increase in diameter and protrusion limited to the areolar region
  • GRADE II: Hypertrophy of all the structural components of the breast; the NAC is above the IMF
  • GRADE III: Hypertrophy of all the structural components, NAC at the same height as or approximately 1 cm below the IMF; in this group we can also include male tuberous breast
  • GRADE IV: Hypertrophy of all the structural components, NAC >1 cm below the IMF
Fruhstorfer 2003 Physical Small-to-moderate Moderate-to-large
Mladick 2004 Physical No sagging Slight sagging Moderate sagging Extensive sagging
Monarca 2013 Physical/tis- sue type
  • GRADE I: Minimal hypertrophy (<250 g)
    • IA: Primarily fatty breast tissue
    • IB: Primarily fibrous breast tissue
    • IC: Nipple malposition (upright)
    • ID: Gynoid (rounded) shape of the chest
    • IE: Absence of sternal notch II: Moderate hypertrophy (250–500 g)
  • GRADE IIA: Primarily fatty breast tissue
    • IIB: Primarily fibrous breast tissue with peripheral fat
    • IIC: Nipple malposition (upright or upward)
    • IID: Moderate gynoid shape of the chest
    • IIE: Absence of sternal notch
  • GRADE III: Severe hypertrophy with grade I ptosis (>500 g)
    • IIIA: Fatty and fibrous tissue with ptosis of grade I
    • IIIB: Nipple malposition (upright or upward)
    • IIIC: Severe gynoid shape of the chest
    • IIID: Absence of sternal notch
  • Grade IV: Severe hypertrophy with grade II or III ptosis (>500–700 g) IVA: Fatty and fibrous tissue with ptosis of grade II
    • IVB: Fatty and fibrous tissue with ptosis of with nipple reorientation grade III
    • IVC: Nipple malposition (upright or upward)
    • IVD: Severe gynoid shape of the chest
    • IVE: Absence of sternal notch

The spectrum of gynecomastia severity has been categorized into a grading system:[1][2]

  • Grade I: Minor enlargement, no skin excess
  • Grade II: Moderate enlargement, no skin excess
  • Grade III: Moderate enlargement, skin excess
  • Grade IV: Marked enlargement, skin excess

References

  1. Wollina, U; Goldman, A (June 2011). "Minimally invasive esthetic procedures of the male breast". Journal of cosmetic dermatology. 10 (2): 150–155. doi:10.1111/j.1473-2165.2011.00548.x. PMID 21649820.
  2. Simon BE, Hoffman S, Kahn S (1973). "Classification and surgical correction of gynecomastia". Plast Reconstr Surg. 51 (1): 48–52. PMID 4687568.

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