Grading the Severity of Gynecomastia

Affecting at least 60% of all men at some time in their life is the development of female type breasts known as gynecomastia. The most prevalent time is the adolescent years as young men pass through puberty. As their hormones are changing and the estrogen level is temporarily high they may have what is referred to as “puffy nipples.” Fortunately for most, their gynecomastia will resolve on its own without any intervention. However, for some if their chest is not back to normal after two years it may be permanent, with surgery as the only option.

The American Society of Plastic Surgeons (ASPS) developed a scale to aid in the description of severity and development of gynecomastia.

• Grade I: severity is mild with enlargement centered around the areola
• Grade II: enlargement is moderate without excess skin past the areola
• Grade III: enlargement is moderate with excess skin
• Grade IV: significant enlargement with feminine type breasts and excess skin

Depending on the severity of the gynecomastia will determine how the male breast reduction surgery is to be performed. It is imperative to select a board certified plastic surgeon that has extensive experience with gynecomastia.

For patients with mild to moderate gynecomastia, the less invasive “pull through technique” procedure may be an option. For those with more severe gynecomastia, a “Two Stage Procedure” may be necessary in order to reduce the excess skin.

Gynecomastia Before and After Photo