Gynecomastia classification

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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 may be classified into 11 classification syste,ms based on a total of 10 breast characteristics

• Breast size
• skin redundancy
• skin elasticity
• Breast ptosis
• Tissue predominance
• Upper Abdominal Laxity
• Nipple malposition
• Tuberosity
• Chest shape and Absence of sternal notch
• Breast Skin Elasticity

Classification

First Author	Year	Method of classification	Classification system
Simon	1973	Physical	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
Rohrich	2003	Physical/Tissue type	GRADE 1 : Minimal hyperteophy, (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:

• 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