Grades of Gynecomastia

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Grades of gynecomastia define the severity of gynecomastia symptoms. Gynecomastia is caused by an imbalance of hormones leading to breast tissue growth, also referred to as enlarged male breasts. It can affect males of all ages and is a fairly common disorder that, to some degree, is apparent in up to 70% of adolescent boys due to hormonal changes. Within two years, 75% of gynecomastia in teenagers resolves itself without treatment.

For the other 25%, and those who develop a 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 and is a disorder of the endocrine system. This medical condition can be a source of significant physiological and social stress due to the feminine appearance gynecomastia symptoms give to a man’s chest. Feelings of embarrassment and lack of confidence can interfere with activities such as swimming 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

Category 1 gynecomastia is defined as a small degree of breast tissue enlargement with a localized button of swollen tissue around the areola or the surrounding nipple area. 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 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.


Small Breast Enlargement - Front ViewSmall Breast Enlargement - Photo

Small Breast Enlargement With Localized Around The AreolaSmall Breast Enlargement - Side View



Grade 2 Gynecomastia

Category 2 gynecomastia is defined as mild to moderate breast tissue enlargement. This expands up to the width of the chest and gives the appearance of small male breasts. This grade may be concealed when wearing loose clothing. The most common gynecomastia surgery is performed for men with grade 2 gynecomastia. The standard male breast reduction surgery involves a combination of mammary gland excision and liposuction, which typically produces excellent results with a high rate of patient satisfaction.


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




Grade 3 Gynecomastia

Category 3 gynecomastia is defined as moderate to significant breast enlargement, expanding the chest’s width with excess skin. Although swelling of the breast tissue is considered moderate to severe, this grade is highly visible and often referred to as man boobs. Men who choose to have gynecomastia surgery report increased levels of confidence and overall quality of life.


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




Grade 4 Gynecomastia

Grade 4 gynecomastia is significant breast enlargement with a substantial amount of excess skin. 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, giving their chest a masculine appearance.


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



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

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

  • Genetics — gynecomastia often runs in families.
  • Age — youthful skin is tighter and has a higher elastin and collagen component, which holds the breast tissue more upright. However, as the skin ages, the skin’s elements 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. 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/booths will break down the skin component over time, leading to increased skin laxity.
  • Overall health and wellness can impact the skin’s components and overall fat distribution, contributing to gynecomastia.
  • Anabolic Steroids — used by bodybuilders, are a known cause of gynecomastia, and long-term use will impact the grade of the condition that develops.

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 registered with the American Board of Plastic Surgeons with a special interest in gynecomastia diagnosis and surgical procedures.  


Gynecomastia Surgery

Gynecomastia surgery is a fast and permanent solution for 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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