Gynecomastia classification: Difference between revisions

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! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Classification system}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Classification system}}
|-
|-
|Nydick
|Nydick's
|1961
|1961
|Physical  
|Physical  
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*The increase in [[gland]] volume extends beyond the edge of the [[areola]]
*The increase in [[gland]] volume extends beyond the edge of the [[areola]]
|-
|-
|Tanner
|Tanner's
|1971
|1971
|Physical  
|Physical  
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*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
|-
|-
|Simon
|Simon's
|1973
|1973
|Physical  
|Physical  
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* GRADE 3: Marked [[breast]] enlargement with marked skin redundancy
* GRADE 3: Marked [[breast]] enlargement with marked skin redundancy
|-
|-
|Deutinger and Freilinger  
|Deutinger's and Freilinger's
|1986
|1986
|Physical  
|Physical  
Line 50: Line 50:
*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]]
|-
|-
|Cohen  
|Cohen's
|1987
|1987
|Physical  
|Physical  
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*Group:4 [[Adipose]] gynecomastia with a slight [[glandular]] component
*Group:4 [[Adipose]] gynecomastia with a slight [[glandular]] component
|-
|-
|Rohrich  
|Rohrich's
|2003
|2003
|Physical/Tissue type
|Physical/Tissue type
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* 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]]
|-
|-
|Gusenoff
|Gusenoff's
|2008
|2008
|Physical
|Physical
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* GRADE 3: NAC and IMF below the ideal IMF, lateral chest roll, significant upper abdominal laxity
* GRADE 3: NAC and IMF below the ideal IMF, lateral chest roll, significant upper abdominal laxity
|-
|-
|Barros
|Barros's
|2012
|2012
|Physical
|Physical
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* 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)
|-
|-
|Çi̇l
|Çi̇l's
|2012
|2012
|Imaging (computed tomography)
|Imaging (computed tomography)
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* Gynecomastic [[adipose]] tissue/total gynecomastic tissue, >0.6
* Gynecomastic [[adipose]] tissue/total gynecomastic tissue, >0.6
|-
|-
|Cordova
|Cordova's
|2008
|2008
|Physical
|Physical
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* 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
|-
|-
|Fruhstorfer
|Fruhstorfer's
|2003
|2003
|Physical
|Physical
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* Moderate-to-large
* Moderate-to-large
|-
|-
|Mladick
|Mladick's
|2004
|2004
|Physical
|Physical
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* Extensive sagging
* Extensive sagging
|-
|-
|Monarca
|Monarca's
|2013
|2013
|Physical/tissue type
|Physical/tissue type
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** IVE: Absence of sternal notch
** IVE: Absence of sternal notch
|-
|-
|Ratnam
|Ratnam's
|2009
|2009
|Physical
|Physical
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* Type 3: Ptotic [[breasts]] with inelastic skin
* Type 3: Ptotic [[breasts]] with inelastic skin
|-
|-
|Webster
|Webster's
|1946
|1946
|Tissue type
|Tissue type

Revision as of 18:30, 29 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.

Classification

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

Surgical classification of gynecomastia

Author Year Method of classification Classification system
Nydick's 1961 Physical
  • Gland limited to the retro areolar region and 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's 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's 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's and Freilinger's 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's 1987 Physical
Rohrich's 2003 Physical/Tissue type
Gusenoff's 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's 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's 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's 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's 2003 Physical
  • Small-to-moderate
  • Moderate-to-large
Mladick's 2004 Physical
  • No sagging
  • Slight sagging
  • Moderate sagging
  • Extensive sagging
Monarca's 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's 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's 1946 Tissue type

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

Classification based on severity

Gynecomastia can be classified on the basis of severity as:

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

Classifcation based on etiology

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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