Types of Gynecomastia: Differentiating Between Different Forms of the Condition

types of gynaecomastia

Gynecomastia is the medical term for male breast enlargement. The psychological influence on a man's confidence necessitates a nuanced understanding of the condition. This article delves into the various types of gynecomastia tissue, offering insights into the stages of gynecomastia, the intricacies of surgical interventions, and treatment modalities.

By comprehending these nuances, individuals can decide their desired treatment paths, like male breast reduction or gynecomastia surgery. Let's dive into the details of gynecomastia to make it easier for men with the condition to take control of their appearance and confidence.

Classifying Gynaecomastia

Before getting into the classification of gynecomastia tissue and gynaecomastia stages, it is imperative to establish a foundational understanding of the condition itself. Gynecomastia is characterised as a benign enlargement of the male breast, typically showing bilaterally but occasionally presenting unilaterally.

This enlargement stems from a proliferation of the glandular component of the breast, as illustrated in the accompanying image. Clinically, it is defined by the presence of a rubbery or firm mass extending concentrically from the nipples. It is crucial to distinguish gynecomastia from pseudogynecomastia (lipomastia), a condition marked by fat deposition without accompanying glandular proliferation.

The classification of gynecomastia has evolved over the years to provide a comprehensive understanding of its various presentations. In 1973, Simon, Hoffman, and Kahn introduced a classification based on the extent of breast enlargement, skin excess, and ptosis (drooping of the upper eyelid). Later, in 2003, Rohrich proposed a refined classification. Let's understand both the classifications:

Simon, Hoffman, and Kahn Classification (1973):

Grade I:

  • Small enlargement with no skin excess.
  • Clinical Characteristics: Minimal breast enlargement without apparent skin sagging.

Grade IIA:

  • Moderate enlargement with no skin excess.
  • Clinical Characteristics: Moderate breast enlargement without visible skin sagging.

Grade IIB:

  • Moderate enlargement with extra skin.
  • Clinical Characteristics: Moderate breast enlargement accompanied by noticeable skin excess.

Grade III:

  • Marked enlargement with extra skin.
  • Clinical Characteristics: Significant breast enlargement with visible skin sagging.

Rohrich Classification (2003):

Grade I:

  • Minimal hypertrophy (<250 G) without ptosis.
  • Clinical Characteristics: Mild breast enlargement without noticeable sagging.

Grade II:

  • Moderate hypertrophy (250–500 G) without ptosis.
  • Clinical Characteristics: Moderate breast enlargement without apparent sagging.

Grade III:

  • Severe hypertrophy (>500 G) with Grade I ptosis.
  • Clinical Characteristics: Significant breast enlargement with mild sagging.

Grade IV:

  • Severe hypertrophy with Grade II or Grade III ptosis.
  • Clinical Characteristics: Significant breast enlargement with noticeable sagging.

Gynaecomastia Stages or Types of Gynaecomastia

Gynecomastia, initially seen as an uncomplicated condition, comes in different severe gynecomastia, each needing a specific treatment approach. Identifying the type accurately is essential for a right and personalised procedure. Here's an overview of the six gynaecomastia stages or types:

1. Puffy Nipple - Type One Gynecomastia:

Type one gynecomastia is prevalent among younger men, notably teenagers and those in their 20s. Despite having a firm and tight skin, this type is characterised by over-protruding nipples, causing poor self-image and social anxiety. Surprisingly, even individuals in excellent physical shape, such as bodybuilders or athletes, can experience this condition. The primary cause is an excess of glandular tissue, which can be surgically addressed through a straightforward procedure.

2. Rounded Chest - Type Two Gynecomastia:

Type two gynecomastia presents with slightly rounded breasts extending just beyond the edge of the pec muscles. Common during puberty, it may persist into one's 20s and 30s. Troublesome when wearing fitted clothing, this type can lead to social avoidance and anxiety. If diet and exercise prove ineffective, surgical intervention becomes a viable option.

3. Slight Breast Roll - Type Three Gynecomastia:

Typically found in adult men, type three gynecomastia results in breast tissue spilling several centimetres over the chest crease, mimicking a female profile. Ignoring type two gynecomastia can lead to its progression. Given its occurrence in older men with less elastic skin, treatment involves the removal of excess glandular tissue through crescent incisions at the areolas. It flattens the chest and restores a more conventionally masculine appearance.

4. Moderate Breast Roll - Type Four Gynecomastia:

Type four gynecomastia involves rounding of the breast, creating a small yet noticeable roll below the chest crease with drooping nipples. Common in men who ignore the severe gynecomastia issue earlier in life, it worsens with age due to decreasing skin elasticity. Surgical intervention removes excess glandular tissue, with additional steps to address skin laxity. Well-camouflaged incisions at the nipple and chest crease are made during the procedure.

5. Significant Breast Roll - Type Five Gynecomastia:

Individuals with type five gynecomastia may have experienced significant weight loss or still be overweight. This complex type, challenging to treat, requires a highly skilled surgeon. The excess glandular tissue affecting the breasts may extend into the armpit, and sagging skin is prevalent.

6. Breast Roll / Back Roll - Type Six Gynecomastia:

Afflicting individuals who may be obese or have undergone major weight loss, type six gynecomastia is characterised by giant, unwanted breasts. In addition to chest imperfections, significant sagging and drooping skin make wearing fitted clothing challenging. Individuals may suffer from depression and anxiety due to type six severe gynecomastia.

How to Treat Gynaecomastia?

When examining gynecomastia, a healthcare professional initiates the process by conducting a comprehensive examination. It involves inquiring about symptoms and medications. A physical exam is then performed to assess the breast tissue, stomach area, and genitals.


To pinpoint gynaecomastia stages and potential causes and rule out other conditions, a series of tests are prescribed:

  • Blood Tests: To analyse hormonal levels and identify abnormalities.
  • Mammograms: X-ray imaging of the breast to check for any abnormalities or signs of breast cancer.
  • CT Scans (Computerized Tomography): A series of X-rays from different angles to provide detailed images.
  • MRI Scans (Magnetic Resonance Imaging): Using a magnetic field and radio waves for detailed imaging.
  • Testicular Ultrasounds: Utilizing sound waves to create images of the testicles and surrounding tissue.
  • Tissue Biopsies: Removing a small piece of tissue for laboratory analysis to rule out breast cancer.

Treatments for Gynaecomastia

How to treat gynecomastia varies, offering options from simple lifestyle changes to medical interventions. This section explores the different approaches to help individuals make informed decisions to improve physical comfort and confidence.


Gynecomastia often resolves on its own, especially during puberty. Regular checkups, scheduled every 3 to 6 months, may be recommended for teenagers to monitor changes over time.


If gynecomastia persists or causes discomfort, medications are considered. These include:


  • Examples: Flutamide, Finasteride (Proscar, Propecia), Spironolactone (Aldactone, Carospir).
  • Indications: Used for conditions such as enlarged prostate and prostate cancer.

Anabolic Steroids and Androgens:

  • Indications: Used to address delayed puberty or muscle loss from other diseases.

ADHD Medicines:

  • Example: Adderall (contains amphetamines).

Anti-Anxiety Medications:

  • Example: Diazepam (Valium).


When conservative measures prove insufficient, different gynecomastia stages surgical options become viable:

  • Liposuction: Removes excess breast fat without affecting gland tissue.
  • Mastectomy: Removes the breast gland tissue. Modern techniques allow for smaller incisions, minimising recovery time. In some instances, liposuction and mastectomy are combined for optimal outcomes.


To sum it up, while gynecomastia itself isn't a major health issue, seeking help is crucial if it's causing discomfort. Talking to a doctor early can make a real difference in understanding gynaecomastia stages and managing symptoms. Doctors can figure out the right treatment plan and address concerns related to gynecomastia. It's completely normal, especially for young boys experiencing changes, to reach out for medical support. Remember, reaching out for help is a positive move towards feeling better physically and emotionally.