Gyno Grades

Gynecomastia is an embarrassing condition that is more common than people think. Characterized by excessive breast growth, the condition can affect infants, teen boys, and older men. Around 65% of all men will experience gynecomastia in their lifetimes. In many cases, the condition will go away on its own within two years. Gynecomastia surgery is the only way to permanently treat the condition, which has many causes. 

The condition is typically caused by a hormonal imbalance or underlying disease. Other causes include genetic factors and some medications. 

The condition causes the breast growth around the chest to expand beyond normal levels. When diagnosed by a doctor or gynecomastia surgeon, various grades are used to determine the severity of the condition, the primary cause, skin quality, and best form of treatment. 

Types and Grades of Gynecomastia

There are 4 grades of gynecomastia that range from mild to severe. 

Grade 1: Mild Enlargement with a Lack of Excess Skin

Boys and men with grade one breast growth have localized tissue behind the areola. Men with grade 1 gynecomastia typically have puffy nipples with good skin quality. Grade one means that only excess glandular tissue is present without the appearance of extra skin. 

Garde 1 gynecomastia

Grade 2: Moderate Enlargement with No Excess Skin

Grade 2 gynecomastia is only slightly more severe than grade one. The condition is characterized by breast growth that extends beyond the areola with indistinct borders along the chest. There may be fatty tissue present alongside glandular tissue but there is not usually any extra skin. 

Grade 2 gynecomastia

Grade 3: Moderate Enlargement with Excess Skin

Grade 3 gynecomastia bears a similarity to grade 2 with extra skin also present. Men with grade 3 have lost skin elasticity, which causes the skin around the chest to become loose and saggy. Grade 3 gynecomastia usually contains both fatty tissue and glandular tissue.

Gynecomastia grades 3

Grade 4: Severe Enlargement with Excess Skin

Grade 4 gynecomastia is severe enough to make the chest appear feminized. This grade is characterized by significant enlargement and skin laxity, causing the appearance of female breasts. We usually see this severity in aging men with poor skin quality. 

Gynecomastia grade 4

Unilateral vs Bilateral Gynecomastia

During a gynecomastia diagnosis, the doctor or gynecomastia surgeon will also determine if the condition appears in both breasts or a single breast. Unilateral gynecomastia means that asymmetry is present, which means only one side of the chest is affected. Bilateral gynecomastia shows symmetry in that both sides of the chest are equally affected. In some cases, bilateral gyno can have one chest appear more severe than the other. 

True Gynecomastia vs. Pseudogynecomastia

When diagnosing gynecomastia, doctors will identify the cause of the condition to determine the type of treatment needed. True gynecomastia is classified as excess glandular tissue, which causes enlarged breasts. Pseudogynecomastia is composed of mainly fat, not glandular breast tissue. Men who are overweight or obese typically have pseudogynecomastia.

How is Gynecomastia Diagnosed?

To provide an accurate diagnosis for gynecomastia, a physical examination will be conducted by a board-certified cosmetic surgeon who specializes in gynecomastia. This exam is necessary to determine the cause of the condition, grade, and best treatment for permanent correction.

How Do Gynecomastia Grades Form?

Male breast growth expands due to the same mechanisms that cause female breasts to grow – a hormonal imbalance. When female androgens overtake male testosterone in the body, the result is larger breasts. Hormones fluctuate naturally during puberty, which can lead to gynecomastia during a boy’s teenage years. Other reasons for the imbalance of hormones include illegal drug use, steroid abuse, and some underlying conditions. Medications can also lead to breast growth in some cases. 

The various grades of gynecomastia form due to:

Age-Related Factors

Older men tend to lose skin elastin and collagen, which results in droopy or saggy skin. Men also tend to lose testosterone to increasing degrees past age thirty. The result of these two factors combined can lead to moderate or severe gynecomastia. 

Genetic Factors

When gynecomastia runs in families, boys and men from that genetic line are at an increased risk of forming the condition. 

Weight Related Factors

Both male and female breasts are largely composed of adipose tissue, otherwise known as fat. Gaining weight can make gynecomastia more pronounced. When weight gain becomes severe, the skin loses elasticity, which can produce the appearance of saggy breasts. 

Environmental Factors

Engaging in unhealthy habits like drug use, steroid abuse, and getting too much sun exposure can further sap the skin of vital components like elastin and collagen. The worse your skin quality, the greater amount of sag you can experience, which can exacerbate the appearance of male breast growth.

How Does Gynecomastia Surgery Permanently Correct Male Breast Growth?

Gynecomastia surgery is the best method we currently have for permanently correcting the condition of excess male breast growth. Otherwise referred to as male breast reduction, gynecomastia surgery can be tailored to the male patient depending on the grade and cause of the condition.A combination of liposuction, tissue excision, and minimally invasive gland removal are used to varying degrees. General anesthesia is also used to ensure you remain unconscious for the duration of the procedure. 

For grade 1 gynecomastia where puffy nipples are present, the surgeon can reposition and resize the areolas to create symmetry around the chest. 
Liposuction is often used for all grades of gynecomastia to remove fatty tissue and shrink the chest to a more masculine size and shape.

An old man with gunecomastia

Only glandular growth can permanently remove the breast growth that is present with all 4 gynecomastia grades. Once the glandular tissue is removed, regrowth is unlikely. Engaging in the same behaviors that caused the condition, such as steroid abuse, can lead to the need for follow-up surgery.

In severe cases, where excess skin is also present, skin excision removes the removal of the extra skin to leave the chest flat and symmetrical. 

Due to advances in gynecomastia surgery techniques and technology, the incisions used during surgery are small, which leaves nearly hidden scars. The result of surgery leaves the chest appearing natural, with improved results over time

How Long is Recovery After Gynecomastia Surgery?

Advancements in breast reduction surgery also mean you should have an easy recovery. You may experience bruising and swelling after the procedure, which will subside in a few days or weeks. You will be asked to wear a compression garment for a couple of weeks to aid with and speed up healing. In some cases, tubes will be inserted into the surgical treatment site to help with fluid collection. These tubes will be removed at your follow-up appointment. 

Your recovery will be spent at home. To make this time easier on you, your gynecomastia surgeon will provide you with home care instructions. These include methods for keeping your surgical treatment site clean and how to sleep comfortably through the night. You will also be advised to stay hydrated, eat healthily, and get adequate sleep. 

You should be able to return to your normal activities within 2 to 3 weeks following gynecomastia surgery. You should refrain from engaging in heavy lifting for a few weeks at least, to prevent pulling against the surgical site. Your chest should be fully healed within 6 to 8 weeks, depending on how quickly your body heals. 

Are There Risks to Gynecomastia Surgery?

All surgeries come with risks. Gynecomastia surgery risks include the typical risks that come with the use of anesthesia, excess bleeding, infection, breast asymmetry, and an unfavorable outcome. You can prevent side effects by choosing your gynecomastia surgeon wisely.

Schedule a Discrete Consultation with Dr. Babak Moeinolmolki

Now that you know more about the various grades and causes of gynecomastia, are you ready to discuss permanent treatment? If you have been living with the condition, and it causes embarrassment and a diminished quality of life, Doctor Babak Moeinolmolki would like to meet with you.

Schedule a discrete consultation with gynecomastia doctor by calling the Gynecomastia Center of Los Angeles. After a quick physical exam and discussion that revolves around your aesthetic goals, Doctor Moeinolmolki can help you determine the grade, cause, and best treatment for your condition. Call +1-310-956-4326 to begin the process.

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