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
Common features included in different gynecomastia classification systems included:[1][2][3]
Breast size
Skin redundancy
Breast ptosis
Tissue predominance
Upper abdominal laxity
Breast tuberosity
Nipple malposition
Chest shape
Absence of sternal notch
Breast skin elasticity
===Classification based on sugical management===[3]
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.
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
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
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
Classification based on severity
Gynecomastia can be graded on the basis of severity as:[4][5][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 pathogenesis
Physiological
Pathological
Due to excess unopposed estrogen to androgen ratio.
↑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. PMID21649820.