Gynecomastia classification

Jump to navigation Jump to search

Gynecomastia Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Gynecomastia from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic study of choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Gynecomastia classification On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Gynecomastia classification

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Gynecomastia classification

CDC on Gynecomastia classification

Gynecomastia classification in the news

Blogs on Gynecomastia classification

Directions to Hospitals Treating Gynecomastia

Risk calculators and risk factors for Gynecomastia classification

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
    • 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:[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

  1. 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.
  2. 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.
  3. Simon BE, Hoffman S, Kahn S (1973). "Classification and surgical correction of gynecomastia". Plast Reconstr Surg. 51 (1): 48–52. PMID 4687568.

Template:WH Template:WS