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 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
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
|
Classification based on severity
Gynecomastia can be graded on the basis of severity as:[2][3] [1]
- 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.
References
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