Rohrich classified gynecomastia based on physical features. This can help determine the appropriate therapy. The authors are from University of Texas Southwestern Medical Center in Dallas.
Parameters:
(1) breast hypertrophy, based on tissue weight
(2) consistency
(3) glandular ptosis
Hypertrophy |
Consistency |
Ptosis |
Grade |
minimal (< 250 grams) |
primarily glandular |
absent |
IA |
|
primarily fibrous |
absent |
IB |
moderate (250 - 500 grams) |
primarily glandular |
absent |
IIA |
|
primarily fibrous |
absent |
IIB |
severe (> 500 grams) |
any |
Grade I |
III |
|
any |
Grade II or III |
IV |
where:
• I assume the hypertrophy weight is for a single breast, rather than for both together. According to the text (page 909), gynecomastia is bilateral in 25-75% of patients.
• Consistency is determined by pinching tissue medially, laterally and below the nipple-areola complex.
• Glandular ptosis was not defined, but based on the photographs in the paper appears to indicate drooping of the nipple-areola complex.
• I am not sure how the weight of breast tissue can be measured prior to excision. If the excess tissue has a uniform consistency, it could be estimated based on volume and density.
• The normal male nipple-areola complex is 2.8 cm in diameter (range 2-4 cm) and located over the 4th intercostal space. The nipple to sternal notch distance is about 20 cm.
The grade of gynecomastia can help guide management:
(1) Usually the patient is observed if the gynecomastia is < 12 months in duration. The tissue tends to become more fibrous with time.
(2) Ultrasound-guided liposuction can be used for any type.
(3) Suction-assisted liposuction can be used for Grades IA or IIA.
(4) Staged excision of residual tissue can be performed in Grades III or IV at 6-9 months after liposuction. This allows for maximal skin retraction.
Specialty: Urology