What are the Grades of Gynecomastia?

Many men know gynecomastia as having male breasts, but it might surprise you to learn that it can be a little more complicated than that. Much study and thought have been put into gynecomastia surgery by plastic surgeons, and it can be helpful to know more about the ways that your board-certified plastic surgeon will approach your gynecomastia treatment from a medical standpoint. Different grades of gynecomastia refer to the degree of male breast enlargement – and each grade may require a different treatment approach. Here’s what to know about the grades of gynecomastia and how it impacts your surgical procedure with Dr. Miguel Delgado.

About Gynecomastia

Gynecomastia is often used as a general term to refer to male breasts. The appearance of gynecomastia can be caused by fatty tissue brought about by weight gain – but this is not considered “true gynecomastia.” Gynecomastia actually refers to the growth of glandular tissue (or breast tissue present in both male and female breasts) that causes an appearance similar to female breasts. Although there may be excess fat involved, at its core gynecomastia is caused by breast growth – potentially even causing breast asymmetry.

Causes of Gynecomastia

There are a variety of causes of gynecomastia like hormone levels, certain medications like anti-anxiety medications, anabolic steroids, and more. It’s common to experience gynecomastia during puberty because of hormone fluctuations. However, for some men, gynecomastia persists or occurs as an adult. Whatever the cause, it can be significantly disruptive to your confidence and emotional well-being.

Gynecomastia Treatment

One of the most effective ways to go about the treatment of gynecomastia is through male breast reduction surgery. This procedure can remove excess breast tissue, excess fat, and excess skin to create a more masculine appearance to the chest. However, different surgical techniques are often required for different grades of gynecomastia. This is one of the many reasons why it’s essential to choose an experienced, board-certified plastic surgeon for your breast reduction procedure.

Grades of Gynecomastia

There are four grades or types of gynecomastia widely accepted by gynecomastia surgeons. They refer to the amount of growth and sagging present in the male breast. Each grade requires a different approach to surgical treatment for male breast reduction, so here’s a breakdown of each grade and what it means for your gynecomastia surgery.

Grade 1

Grade 1 has the smallest amount of male breast tissue – it’s typically felt just under the nipple and areola with a physical exam or the Pinch Test. It often feels like a small, firm button that causes a noticeable protrusion of the male breast. Although the degree of male breast enlargement for this grade is minimal, it can still cause significant emotional distress, especially in situations where it’s common to take your shirt off. Generally, gynecomastia surgery can be a good option for grade 1 if it doesn’t resolve on its own or with other treatment options.

Grade 2

Grade 2 includes more moderate breast enlargement and is the most common grade. This degree of male breast growth gives more of an appearance of a male breast and can expand up to the width of the chest muscles. Although grades 1 and 2 can be concealed with loose clothing, grade 2 may be more noticeable with certain shirts. Grade 2 is typically best treated with gynecomastia surgery using a combination of excision and liposuction to remove excess tissue (both fat and breast tissue).

Grade 3

Grade 3 begins to create the appearance of enlarged male breasts and is what most people refer to as “man boobs.” This degree of enlarged glandular tissue can be very noticeable even with clothing and may even begin to include sagging, excess skin. Male breast reduction for this degree of gynecomastia begins to require advanced techniques to remove male breast glandular tissue.

Grade 4

Grade 4 can resemble female breasts and have more significant amounts of skin and sagging. This grade of gynecomastia persists because it’s often tied to underlying health problems. This severe gynecomastia can drastically reduce your confidence even when wearing clothing. Surgical treatment of gynecomastia for grade 4 can be complex and requires extensive knowledge of male breast reduction surgery.

Two Stage Gynecomastia Surgery for Grade 3 and Grade 4

The two-stage gynecomastia surgery is often recommended by Dr. Delgado for grades 3 and 4. With decades of experience in plastic surgery and male breast reduction, Dr. Delgado achieves excellent results for men struggling with higher grades of gynecomastia.

The two-stage procedure begins with a traditional male breast reduction surgery where the excess breast tissue is removed through a small incision at the edge of the areola. Fat is removed using liposuction, and the skin is restored to a more upright position to flatten the chest. This part of the procedure is performed with general anesthesia as an outpatient procedure.

The second stage is performed later as an in-office procedure with local anesthesia. It’s a procedure typically performed because skin is still a concern after the initial procedure. During this step, a small section of skin is removed around the nipple and areola, and a permanent suture is placed around the area. This tightens the skin further and removes any contour irregularities that may be caused by excess fat or breast tissue left over in the lower breast fold.

Together, these two steps produce excellent results for men who have higher grades of gynecomastia. In fact, it’s one of the most effective male breast reduction techniques to date for higher degrees of gynecomastia. Dr. Delgado is one of the few gynecomastia surgeons here in the greater San Francisco area to perform this plastic surgery technique – during a consultation, he can help you learn more about male breast reduction surgery and what you can expect from our premier clinic.

Your Gynecomastia Consultation

Your first step is a consultation with Dr. Delgado where you’ll learn more about gynecomastia, male breast reduction, and the right surgical approach for your needs. Dr. Delgado can examine your chest and help you determine which grade of gynecomastia is most appropriate and how it will impact your male breast reduction procedure. Dr. Delgado is widely known as one of the leading male breast reduction surgeons in the country and will spend significant time helping you understand your male breast reduction options.

Schedule a Consultation

To learn more about male breast reduction surgery and how Dr. Delgado can help you achieve a new level of confidence, contact our San Francisco and Novato, CA offices today by calling or filling out our online form.

Gynecomastia FAQs

Does grade 2 gynecomastia go away?

It’s possible for grade 2 gynecomastia to resolve on its own, depending on the underlying causes. It may also be possible for grade 2 gynecomastia to go away with appropriate lifestyle changes.

How much does male breast reduction cost?

Each patient is unique when it comes to the specific details and cost of a procedure. Dr. Delgado will give you a full cost estimate during your consultation.

What’s the difference between grade 1 and grade 2 gynecomastia?

Grades 1 and 2 do not include excess skin – rather, there’s only enlargement of the underlying breast tissue. In grade 1, this enlargement is considered small, while grade 2 is considered moderate.

Does estrogen cause gynecomastia?

Estrogen imbalance is thought to be one of the main causes of gynecomastia. Although men naturally have small amounts of estrogen, too much can cause breast tissue to enlarge. For this reason, lower grades of gynecomastia may sometimes be treated by reducing estrogen levels.

Is gynecomastia associated with breast cancer?

Breast cancer in men is very rare, but there is an increased risk of breast cancer with gynecomastia because of the growth of breast tissue. More often (but still very rarely) gynecomastia can be a sign of testicular cancer in certain age groups.


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Dr. Miguel Delgado


Dr. Delgado, MD is a world-recognized plastic surgeon and specialist in the treatment of male breast enlargement, also called gynecomastia. He has developed new techniques and owns and operates gynecomastia.org, which has become the largest gynecomastia forum in the world. Dr. Delgado holds the two most coveted credentials; the certification by the American Board of Plastic Surgery and membership in the American Society of Plastic Surgery.

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