Patients present with an increase in breast tissue, which is asymmetric in one third of cases. The degree of asymmetry between the 2 sides varies widely. Some patients present with unilateral gynecomastia, while other individuals have a size discrepancy between the 2 sides that ranges from moderate to severe. Breast tenderness may also be noted in one third of patients. Enlargement is usually central and symmetric, although occasionally it is eccentric.
In 1934, Webster classified gynecomastia into 3 types.3 The first is glandular. Patients with a glandular component require surgical removal of the gland. The second is fatty glandular. With the fatty glandular form, surgery combined with liposuction allows good contouring. The third is simple fatty. In the cases that are primarily fatty in nature, liposuction alone provides good results.
Another classification described by Simon in 1973 groups the patients into categories according to the size of the gynecomastia.10 Group 1 is minor but visible breast enlargement without skin redundancy. Group 2A is moderate breast enlargement without skin redundancy. Group 2B is moderate breast enlargement with minor skin redundancy. Group 3 is gross breast enlargement with skin redundancy that simulates a pendulous female breast. Patients in groups 1 and 2 require no skin excision, but the breast development associated with group 3 is so marked that excess skin must be removed.