Grades of Gynecomastia

The grade of gynecomastia helps to define the severity of the condition universally. We understand that gynecomastia is the enlargement of the breast tissue in men due to an imbalance of hormones. It can affect males of all ages. It is a fairly common disorder that affects, to some degree, up to 70% of adolescent boys due to their hormonal changes at this age. Within two years, 75% of cases resolve themselves without treatment. Gynecomastia affects males to varying degrees. Although it is often confused with weight gain and obesity, gynecomastia is a disorder of the endocrine system and not a weight-related issue. This medical condition can be a source of significant physiological and social stress since it can change the appearance of a man’s body.

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Medical Author: Miguel Delgado, M.D.

Dr. Delgado is a highly skilled surgeon specializing in gynecomastia surgery. Dr. Delgado has committed a significant amount of his practice to the care and education of men and boys with gynecomastia. Dr. Delgado’s practice philosophy is to provide the highest quality of patient care to the people who seek out his professional services. Dr. Delgado and his staff are committed to understanding their patients concerns, educating them on their options, and executing the best surgical outcome for each patient. Dr. Delgado is the new owner of since 2010. He has dedicated a significant part of his life and practice to improving the community.


Four Different Grades of Gynecomastia

The American Society of Plastic Surgery (ASPS) has adopted a descriptive classification system from McKinney and Simon, Hoffman, and Kohn called the gynecomastia scale. It enables specialists to discuss the issues and treatment of gynecomastia in a more standardized fashion. Gynecomastia is classified into four groups according to the severity of the breast tissue enlargement. The four grades of gynecomastia are as follows:


Small Breast Enlargement - Front ViewSmall Breast Enlargement - Photo
Small Breast Enlargement With Localized Around The AreolaSmall Breast Enlargement - Side View


Grade I

Category I gynecomastia is defined as small breast enlargement with a localized button of tissue around the areola or the surrounding nipple area. The slight swelling of this tissue has a different color than the breast tissue in that area. At this grade, the condition is generally not very noticeable with clothing, but it can be quite evident without clothing. Surgery can be a solution when it persists and becomes a psychological and social issue that can alter a young man’s development. The outcome of this surgery is very successful.


Moderate Breast Enlargement - PhotoModerate Breast Enlargement - Front ViewModerate Breast Enlargement Exceeding Areola Boundaries


Grade II

Category II gynecomastia defined as mild to moderate breast enlargement, which expands up to the width of the chest. The tissue is now broader based on the chest. This grade is often unnoticeable when wearing loose clothing. Grade II gynecomastia is the most common type undergoing surgery. The standard male breast reduction surgery of mammary gland excision and liposuction produces excellent results.


Image Moderate Male Breast EnlargementFront View Moderate Male Breast EnlargementModerate Breast Enlargement Exceeding Areola Boundaries With Edges Distinct From The Chest


Grade III

Category III gynecomastia is defined as moderate to significant breast enlargement, expanding the chest’s width with excess skin. Although the swelling of the breast tissue is considered moderate to severe, this grade is highly visible.


Marked Male Breast Enlargement - PhotoMarked Male Breast Enlargement - Front ViewMarked Male Breast Enlargement With Excess Skin And Feminization Of The Breast

Grade IV

Grade IV gynecomastia is a significant breast enlargement with substantial excess skin. This grade is considered severe and highly visible, giving the person a feminine breast appearance. Surgery performed at this grade.

What are some of the factors that determine the grade of gynecomastia?

Many factors can contribute to the grade of gynecomastia, but these are some of the major ones.

  • Genetics – gynecomastia does run in families.
  • Age – youthful skin has much more elastin and collagen component to the skin; therefore, the tight contraction holds the breast tissue more upright. However, as the skin ages, the skin’s elements begin to break down, and sagging occurs. This aging process will advance the grade of gynecomastia. 
  • Weight – the increase in size will increase the circumference of the chest by the fat content, and this can have an overall effect on the grade of gynecomastia. Also, weight loss, especially if it is massive, can severely affect skin quality. The skin components can be permanently altered in a negative way causing skin laxity or sagging. 
  • Sun damage – The effect of ultraviolet light on the skin will break down the skin component over time, causing skin laxity.
  • Overall health and wellness.

If you have more interest in determining the male breast enlargement and treatment grade, consult with a gynecomastia professional. As part of, we have a panel of male breast reduction experts and would be happy to answer questions about grades of gynecomastia in “Ask a Doctor” in the forum.



Gynecomastia: physiopathology, evaluation and treatment

Sao Paulo Med. J. vol.130 no.3 São Paulo 2012

Classification and Management of Gynecomastia: Defining the Role of Ultrasound-Assisted Liposuction

Rod J Rohrich 1, Richard Y Ha, Jeffrey M Kenkel, William P Adams Jr

Plast Reconstr Surg 2003 Feb;111(2):909-23; discussion 924-5.

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The content on is for educational purposes only. It is not intended as medical advice. It does not replace the need to meet with a physician who will accurately diagnose your condition and suggest treatment options.

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