Gynecomastia classification: Difference between revisions

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Revision as of 15:27, 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 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

  • 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
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:[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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