Gynecomastia classification: Difference between revisions

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*Stage 3: Further swelling of the [[breast]] and [[areola]] without separation of their edges
*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 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
*Stage 5: There is protrusion of the [[nipple]] only after retraction of the [[areola]] from the [[breast]] surface
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|Simon
|Simon
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|Physical  
|Physical  
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* GRADE 1: Small visible breast enlargement, no skin redundancy  
* GRADE 1: Small visible [[breast]] enlargement, no skin redundancy  
* GRADE 2a: Moderate [[breast]] enlargement without skin redundancy  
* GRADE 2a: Moderate [[breast]] enlargement without skin redundancy  
* GRADE 2b: Moderate [[breast]] enlargement with skin redundancy  
* GRADE 2b: Moderate [[breast]] enlargement with skin redundancy  
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|Physical  
|Physical  
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*Grade 1: [[Thoracic wall]] poor in the flesh; [[mammary tissue]] localized behind and around the nipple; no skin excess  
*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 2: [[Adipose]] thoracic wall; widespread alterations; [[breast]]s similar to feminine ones during puberty
*Grade 3: Widespread alterations; excess adipose tissue, skin redundancy, inframammary fold and ptosis
*Grade 3: Widespread alterations; excess [[adipose]] tissue, skin redundancy, inframammary fold and [[ptosis]]
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|Cohen  
|Cohen  
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|Physical  
|Physical  
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*Group 1: Glandular gynecomastia
*Group 1: [[Glandular]] gynecomastia
*Group 2: Glandular gynecomastia with ptosis
*Group 2: [[Glandular]] gynecomastia with [[ptosis]]
*Group 2: Glandular gynecomastia with ptosis
*Group 2: [[Glandular]] gynecomastia with [[ptosis]]
*Group 3: [[Adipose]] gynecomastia
*Group 3: [[Adipose]] gynecomastia


*Group:4 Adipose gynecomastia with a slight glandular component
*Group:4 [[Adipose]] gynecomastia with a slight [[glandular]] component
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|Rohrich  
|Rohrich  
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|Physical/Tissue type
|Physical/Tissue type
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* GRADE 1: Minimal hypertrophy, (less than 250g of tissue) without ptosis
* GRADE 1: Minimal [[hypertrophy]], (less than 250g of tissue) without [[ptosis]]
** 1a: Primary glandular
** 1a: Primary [[glandular]]
** 1b: Primarily fibrous
** 1b: Primarily fibrous
* GRADE 2: moderate hypertrophy (250-500g of breast tissue) without ptosis
* GRADE 2: moderate [[hypertrophy]] (250-500g of breast tissue) without [[ptosis]]
** 2a: Primarily glandular
** 2a: Primarily [[glandular]]
** 2b: primarily fibrous
** 2b: primarily fibrous
* GRADE 3: Severe hypertrophy (>500g of breast tissue with grade 1 ptosis glandular or fibrous
* GRADE 3: Severe [[hypertrophy]] (>500g of breast tissue with grade 1 ptosis glandular or fibrous
* GRADE 4: Severe hypertrophy with grade 2 or 3 ptosis glandular or fibrous
* GRADE 4: Severe [[hypertrophy]] with grade 2 or 3 [[ptosis]] [[glandular]] or [[fibrous]]
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|Gusenoff
|Gusenoff
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|Physical
|Physical
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* GRADE I: Increased diameter and slight protrusion limited to the areola region  
* GRADE I: Increased diameter and slight protrusion limited to the [[areola]] region  
* GRADE II: Moderate [[hypertrophy]] of the breast with the nipple-areola complex (NAC) above the inframammary fold (IMF)  
* GRADE II: Moderate [[hypertrophy]] of the [[breast]] with the nipple-areola complex (NAC) above the inframammary fold (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 inframammary fold (IM)
* 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 inframammary fold (IM)
* Grade IV: Major breast hypertrophy with skin redundancy, severe ptosis, and the NAC positioned ≥1 cm below the inframammary fold (IMF)
* Grade IV: Major [[breast]] [[hypertrophy]] with skin redundancy, severe [[ptosis]], and the NAC positioned ≥1 cm below the inframammary fold (IMF)
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|Çi̇l
|Çi̇l
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|Imaging (computed tomography)
|Imaging (computed tomography)
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* Gynecomastic adipose tissue/total gynecomastic tissue, <0.3
* Gynecomastic [[adipose]] tissue/total gynecomastic tissue, <0.3


* Gynecomastic adipose tissue/total gynecomastic tissue, 0.3–0.5  
* Gynecomastic [[adipose]] tissue/total gynecomastic tissue, 0.3–0.5  


* Gynecomastic adipose tissue/total gynecomastic tissue, >0.6
* Gynecomastic [[adipose]] tissue/total gynecomastic tissue, >0.6
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|Cordova
|Cordova
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|Physical
|Physical
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* GRADE I: Increase in diameter and protrusion limited to the areolar region  
* 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 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 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
* GRADE IV: [[Hypertrophy]] of all the structural components, NAC >1 cm below the IMF
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|Fruhstorfer
|Fruhstorfer
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|Physical/tissue type
|Physical/tissue type
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* GRADE I: Minimal hypertrophy (<250 g)  
* GRADE I: Minimal [[hypertrophy]] (<250 g)  
** IA: Primarily fatty breast tissue  
** IA: Primarily fatty [[breast]] tissue  
** IB: Primarily fibrous breast tissue  
** IB: Primarily fibrous [[breast]] tissue  
** IC: Nipple malposition (upright)  
** IC: [[Nipple]] malposition (upright)  
** ID: Gynoid (rounded) shape of the chest  
** ID: Gynoid (rounded) shape of the chest  
** IE: Absence of sternal notch II: Moderate hypertrophy (250–500 g)  
** IE: Absence of sternal notch II: Moderate [[hypertrophy]] (250–500 g)  
* GRADE IIA: Primarily fatty breast tissue
* GRADE IIA: Primarily fatty [[breast]] tissue
** IIB: Primarily fibrous breast tissue with peripheral fat  
** IIB: Primarily fibrous [[breast]] tissue with peripheral fat  
** IIC: Nipple malposition (upright or upward)  
** IIC: [[Nipple]] malposition (upright or upward)  
** IID: Moderate gynoid shape of the chest  
** IID: Moderate gynoid shape of the chest  
** IIE: Absence of sternal notch  
** IIE: Absence of sternal notch  
* GRADE III: Severe hypertrophy with grade I ptosis (>500 g)  
* GRADE III: Severe [[hypertrophy]] with grade I [[ptosi]]s (>500 g)  
** IIIA: Fatty and fibrous tissue with ptosis of grade I
** IIIA: Fatty and fibrous tissue with [[ptosis]] of grade I
** IIIB: Nipple malposition (upright or upward)  
** IIIB: [[Nipple]] malposition (upright or upward)  
** IIIC: Severe gynoid shape of the chest  
** IIIC: Severe gynoid shape of the chest  
** IIID: Absence of sternal notch  
** 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  
* 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  
** IVB: Fatty and fibrous tissue with [[ptosis]] of with [[nipple]] reorientation grade III  
** IVC: Nipple malposition (upright or upward)  
** IVC: [[Nipple]] malposition (upright or upward)  
** IVD: Severe gynoid shape of the chest  
** IVD: Severe gynoid shape of the chest  
** IVE: Absence of sternal notch
** IVE: Absence of sternal notch
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|Physical
|Physical
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* Type 1: Enlarged breasts with elastic skin and no fold
* Type 1: Enlarged [[breasts]] with elastic skin and no fold


* Type 2: Enlarged breasts with elastic skin and an IMF  
* Type 2: Enlarged [[breasts]] with elastic skin and an IMF  


* Type 3: Ptotic breasts with inelastic skin
* Type 3: Ptotic [[breasts]] with inelastic skin
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|Webster
|Webster
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|Tissue type
|Tissue type
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* Class 1: Periductal connective  tissue hypertrophy without adipose tissue change  
* Class 1: Periductal connective  tissue [[hypertrophy]] without [[adipose]] tissue change  
* Class 2: Increase in the amount of both connective and adipose tissue
* Class 2: Increase in the amount of both connective and [[adipose]] tissue
* Class 3: Adipose tissue hypertrophy alone
* Class 3: [[Adipose]] tissue [[hypertrophy]] alone
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<nowiki>*</nowiki>NAC, nipple-areola complex; IMF, inframammary fold
<nowiki>*</nowiki>NAC, nipple-areola complex; IMF, inframammary fold

Revision as of 16:47, 21 August 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2], Omodamola Aje B.Sc, M.D. [3]

Overview

Gynecomastia has been classified by various systems mainly based on surgical management, the severity of gynecomastia, physical appearance, and etiology. Breast size and ptosis are the most commonly included features.

Classification

Different gynecomastia classification systems are:[1][2][3][4][5][6]

Surgical classification of gynecomastia

Author Year Method of classification Classification system
Nydick 1961 Physical
  • 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
  • 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
  • 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
  • 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
Rohrich 2003 Physical/Tissue type
Gusenoff 2008 Physical
  • GRADE 1: Minimal excess skin and fat, minimal alteration of nipple-areola complex (NAC), inframammary fold (IMF)
    • 1a: No lateral skin roll
    • 1b: Lateral skin roll
    • 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 nipple-areola complex (NAC) above the inframammary fold (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 inframammary fold (IM)
  • Grade IV: Major breast hypertrophy with skin redundancy, severe ptosis, and the NAC positioned ≥1 cm below the inframammary fold (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/tissue 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
Ratnam 2009 Physical
  • Type 1: Enlarged breasts with elastic skin and no fold
  • Type 2: Enlarged breasts with elastic skin and an IMF
  • Type 3: Ptotic breasts with inelastic skin
Webster 1946 Tissue type

*NAC, nipple-areola complex; IMF, inframammary fold

Classification based on severity

Gynecomastia can be graded on the basis of severity as:

  • 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

Classifcation based on pathogenesis

References

  1. ↑ Waltho D, Hatchell A, Thoma A (2017). "Gynecomastia Classification for Surgical Management: A Systematic Review and Novel Classification System". Plast Reconstr Surg. 139 (3): 638e–648e. doi:10.1097/PRS.0000000000003059. PMID 28234829.
  2. ↑ Monarca C, Rizzo MI (2013). "Gynecomastia: tips and tricks-classification and surgical approach". Plast Reconstr Surg. 131 (5): 863e–5e. doi:10.1097/PRS.0b013e318287a18f. PMID 23629140.
  3. ↑ Rohrich RJ, Ha RY, Kenkel JM, Adams WP (2003). "Classification and management of gynecomastia: defining the role of ultrasound-assisted liposuction". Plast Reconstr Surg. 111 (2): 909–23, discussion 924-5. doi:10.1097/01.PRS.0000042146.40379.25. PMID 12560721.
  4. ↑ 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.
  5. ↑ Simon BE, Hoffman S, Kahn S (1973). "Classification and surgical correction of gynecomastia". Plast. Reconstr. Surg. 51 (1): 48–52. PMID 4687568.
  6. ↑ Gikas P, Mokbel K (2007). "Management of gynaecomastia: an update". Int J Clin Pract. 61 (7): 1209–15. doi:10.1111/j.1742-1241.2006.01095.x. PMID 17362482.

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