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
===Classification based on clinical appearance or morphology===[1]
| 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
- 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:[2][3]
- 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 petiology
Physiological
References
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