A New Clinical Classification Method for Gynecomastia Based on Chest Appearance and MR/CT Images.

[BACKGROUND] Classification theories for gynecomastia often conflate breast ptosis degree with subcutaneous soft tissue composition, leading to further confusion in determining appropriate surgical regions and techniques. To address this, we propose a new clinical classification method for gynecomastia.

[METHODS] We first divided each side of male chest into six distinct regions, then separated the concept of grade and type in gynecomastia classification. Five grades were defined based on chest appearance and breast ptosis (skin redundancy). Grade 1-4 Patients underwent surgery in region 1-4 accordingly, with region 5-6 addressed if necessary. Grade 5 patients received treatment in all six regions. Two types with six subtypes were defined based on the proportion and distribution of subcutaneous glandular tissue shown in MR/CT images. Type 1 (A-C) patients typically required liposuction alone, with pull-through added if necessary, while Type 2 (A/B) patients generally required additional pull-through. For Type 2C patients, mammotome-assisted resection was used to remove dense, enlarged glands.

[RESULTS] Two hundred and ninety-seven gynecomastia patients were included in this study. There were 32, 183, 45, 12, and 5 patients in grade 1-5, respectively, along with 20 patients with asymmetric gynecomastia. A total of 132 patients underwent preoperative MR/CT imaging, with 85 classified as Type 1, 39 as Type 2, and 8 as asymmetric cases.

[CONCLUSION] We propose a new gynecomastia classification method based on chest appearance and MR/CT images, distinguishing grade from type. Grade determines the surgical region, while type guides the choice of surgical technique. This approach is objective and clinically meaningful.

[LEVEL OF EVIDENCE IV] This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .