Classification of Rohrich et al for Gynecomastia

 

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.