Grades of Gynecomastia

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Medical Author: Miguel Delgado, M.D.
Dr. Miguel DelgadoDr. 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.


The grade of gynecomastia defines the severity of gynecomastia symptoms. Gynecomastia is most often caused by an imbalance of hormones leading to breast tissue or excess fat growth in men, also referred to as enlarged male breasts. It can affect males of all ages and is a fairly common disorder that affects up to 70% of adolescent boys due to hormonal changes. Fortunately, within two years, 75% of gynecomastia in teenagers resolves itself without the need for treatment.

For the other 25%, and those who develop another type of gynecomastia after puberty, symptoms vary in severity. Although often confused with weight gain and obesity, true gynecomastia is not caused by excess fat but rather a disorder of the endocrine system. This medical condition can be a source of significant physiological and social stress due to the feminine appearance of the man’s chest. Feelings of embarrassment and lack of confidence can interfere with activities where every other man is comfortable going shirtless and have a negative impact on intimate relationships.

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 glandular tissue enlargement. The four grades of gynecomastia are as follows:

Grade 1 Gynecomastia

Grade 1 gynecomastia is defined as a small degree of breast tissue enlargement with a localized button of swollen, excess breast tissue directly under the nipple or the surrounding areola. The tissue has a different color than the surrounding tissue in that area. At grade 1, the condition is generally not noticeable with clothing; however, it can be quite apparent without clothing.

Gynecomastia surgery for this small breast enlargement can be a suitable solution when it does not resolve and becomes a psychological and social issue that may alter a young man’s confidence and development. In almost all grade 1 cases, the outcome of surgery is very successful.

Grade 2 Gynecomastia

Category 2 gynecomastia is defined as mild to moderate breast enlargement. It can expand up to the width of the chest muscles and gives the appearance of small male breasts. This grade of gynecomastia may be concealed when wearing loose clothing.

Grade 2 is the most commonly treated surgical correction of gynecomastia. The standard male breast reduction surgery involves a combination of gland excision and liposuction, which typically produces excellent results with a high rate of patient satisfaction.

Grade 3 Gynecomastia

Category 3 gynecomastia is defined as moderate to significant breast enlargement, expanding the chest’s width with excess skin. At this point, the swelling of the breast tissue is considered moderate to severe, which means this grade is highly visible and often referred to as man boobs. Men who choose to have gynecomastia surgery for grade 3 report increased levels of confidence and overall quality of life, although the surgical procedure does become more complicated at this stage of marked breast enlargement.

Grade 4 Gynecomastia

Grade 4 gynecomastia is significant breast enlargement with a substantial amount of excess skin that resembles sagging female breasts. This grade is considered severe and highly visible, even when fully clothed. Men can be significantly impacted psychologically and socially by the feminine appearance of their chest. Men with grade 4 gynecomastia will normally benefit greatly from surgery to remove the excess tissue and skin, giving their chest a much more masculine appearance.

What Are the Factors That Contribute to the Grade of Gynecomastia?

Many factors can contribute to the grade of gynecomastia a person experiences, but some of the major ones include:

  • Genetics — gynecomastia often runs in families.
  • Age — youthful skin is tighter and has a greater amount of elastin and collagen that hold the breast tissue more upright. However, as the skin ages, these proteins begin to break down, causing skin laxity and sagging. This aging process will advance the grade of gynecomastia. 
  • Weight — excess fat increases the circumference of the chest, which will usually increase the grade of gynecomastia. Additionally, weight loss, especially when significant, can severely affect skin quality and result in redundant skin throughout the body. The skin components can be permanently altered negatively, causing a marked increase in both skin laxity and sagging. 
  • Sun damage — repeated exposure to sunlight or ultraviolet light in tanning beds will break down skin quality over time, leading to increased skin laxity.
  • Anabolic steroids — used by bodybuilders, anabolic steroids are a known cause of gynecomastia, and long-term use will impact the grade of the condition that develops.
  • General health — overall health and wellness can impact the skin’s components and overall fat distribution, contributing to gynecomastia.

A gynecomastia pinch test is a method used to diagnose gynecomastia. However, determining the factors for male breast enlargement and gynecomastia grade requires a consultation with a gynecomastia professional, preferably a plastic surgeon certified by the American Board of Plastic Surgeons with a special interest and expertise in gynecomastia and the relevant surgical procedures.

Gynecomastia Treatment Options

Gynecomastia surgery is a fast and permanent solution to treat gynecomastia, with a high rate of patient satisfaction. When performed by an experienced plastic surgeon using advanced techniques, there is minimal scarring. Following gynecomastia surgery, most men are extremely satisfied with the results, happier, and more confident.

For personalized information about gynecomastia plastic surgery procedures, please complete Dr. Delgado’s inquiry form.

Dr. Delgado is a world-renowned Board-Certified Plastic Surgeon, a member of the American Society of Plastic Surgeons, and a recognized expert in the field of gynecomastia surgical procedures. In 1986, Dr. Delgado founded — the largest international forum providing unprecedented resources about gynecomastia treatments and surgical options.

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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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