How Many Grades Are There in Gynecomastia?

The enlargement of breast tissue in males is known as gynecomastia. It can occur at any age and is often caused by hormone imbalances, medications, or underlying medical conditions. 

Understanding the grade of gynecomastia is crucial for both patients and healthcare providers. It helps in determining the severity of the condition, guiding treatment options, and setting realistic expectations for outcomes. Each grade requires a different approach, ranging from lifestyle changes to surgical intervention. Thus, knowing the grades allows for personalized care and better outcomes for individuals with gynecomastia.

Classification of Gynecomastia Grades

Some categorize gynecomastia in five, some in three, however, most of the experts mention 4 gynecomastia grades based on total hypertrophy levels

Grade I gynecomastia is characterized by minimal hypertrophy (less than 250 grams) of breast tissue without ptosis (sagging). It may appear as a slight enlargement of the breast area, often concentrated around the nipple.

Grade II gynecomastia is considered moderate, with hypertrophy ranging from 250 to 500 grams. In this grade, the enlargement of breast tissue is more noticeable and may have a slight sagging appearance.

Grade III gynecomastia is severe, involving hypertrophy of more than 500 grams with grade I ptosis. This grade is characterized by significant breast development that may resemble female breasts, with noticeable sagging.

Grade IV gynecomastia is the most severe, with hypertrophy exceeding 500 grams and grade II or III ptosis. It presents as significant breast enlargement with pronounced sagging, resembling female breasts in appearance.

Symptoms and Physical Appearance of Each Grade

Here are the symptoms and physical appearance of each grades in gynecomastia –

Grade I gynecomastia typically presents as a small, rubbery lump beneath the nipple area. The breast may appear slightly larger than usual, but the enlargement is not significant and is usually not noticeable under clothing.

Grade II gynecomastia is characterized by more noticeable breast enlargement. The breast tissue may feel firmer and extend outside the areola, giving the chest a more rounded or protruding appearance. Some sagging of the breast tissue may also be present.

Grade III gynecomastia involves significant breast enlargement, with the breast tissue extending beyond the areola and giving the chest a more feminine contour. The breasts may sag noticeably, and the skin may appear stretched.

Grade IV gynecomastia is the most severe, with extensive breast enlargement and pronounced sagging. The breasts may resemble female breasts in appearance, with the breast tissue hanging below the chest and the skin severely stretched.

Treatment Options for Each Grade

A. Grade I

Non-surgical options: For Grade I gynecomastia, non-surgical options are often the first line of treatment. This may include regular monitoring by a healthcare provider to assess any changes in the condition. In some cases, no treatment may be necessary, as Grade I gynecomastia can resolve on its own.

Medications such as selective estrogen receptor modulators (SERMs) or aromatase inhibitors may be prescribed to help reduce breast tissue in Grade I gynecomastia. Lifestyle changes, including maintaining a healthy weight and avoiding substances that can worsen gynecomastia, such as alcohol or certain medications, may also be recommended.

Surgical options: If non-surgical options are not effective or if the gynecomastia is causing significant discomfort or psychological distress, surgical intervention may be considered. Liposuction, a minimally invasive procedure, can remove excess fat from the breast area. In cases where glandular tissue is the primary concern, gynecomastia surgical excision may be necessary.

B. Grade II

Non-surgical options: Similar to Grade I, non-surgical options may be recommended initially for Grade II gynecomastia. This includes regular monitoring, medication, and lifestyle changes.

Surgical options: Surgical options for Grade II gynecomastia may involve more extensive liposuction and excision compared to Grade I, as the breast enlargement is more pronounced.

C. Grade III

Non-surgical options: While non-surgical options may provide some relief for Grade III gynecomastia, they are often less effective due to the severity of the condition. Monitoring, medication, and lifestyle changes may still be considered.

Surgical options: Surgical intervention is typically necessary for Grade III gynecomastia. Liposuction and excision may be performed to address the significant breast enlargement and sagging associated with this grade.

D. Grade IV

Non-surgical options: Non-surgical options may be less effective for Grade IV gynecomastia, as the condition is more severe. However, regular monitoring, medication, and lifestyle changes can still be recommended.

Surgical options: Surgery is almost always necessary for Grade IV gynecomastia. Liposuction and excision are the primary surgical options, aiming to reduce the size of the breasts and improve the chest contour.

Risks and Complications Associated with Gynecomastia Surgery

Gynecomastia surgery, like any surgical procedure, carries general risks such as bleeding, infection, and adverse reactions to anesthesia. These risks are typically low but can vary depending on individual health factors and the extent of the surgery.

  • Hematoma: Collection of blood under the skin, which may require drainage.
  • Seroma: Collection of clear fluid under the skin, which may also require drainage.
  • Changes in nipple or breast sensation: Temporary or permanent changes in sensation around the nipple or breast area.
  • Asymmetry: Unevenness in breast size or shape after surgery, which may require additional procedures for correction.
  • Contour irregularities: Irregularities in the contour of the chest, which may occur if too much fat or tissue is removed unevenly.
  • Scarring: While efforts are made to minimize scarring, some degree of scarring is inevitable with any surgical procedure.
  • Skin necrosis: Rare but possible, where skin tissue does not receive adequate blood supply and may die, requiring further treatment.
  • Need for revision surgery: In some cases, additional surgery may be needed to achieve the desired results or correct any complications that arise.

Recovery Process After Gynecomastia Surgery: Timeline

The recovery timeline after gynecomastia surgery in Delhi can vary depending on the individual and the extent of the procedure. However, here is a general timeline:

  • Immediately after surgery: You will likely experience some discomfort, swelling, and bruising. You may be required to wear a compression garment to help reduce swelling and support the chest area.
  • First week: Most patients can return to work and light activities within a few days to a week after surgery. Avoiding strenuous activity is advised for a minimum of 4-6 weeks.
  • First month: Swelling and bruising should gradually improve. The final results of the surgery may start to become more apparent.
  • Three to six months: Most of the swelling should subside, and the chest contour should continue to improve. Scars will also begin to fade over time.

Post-operative care instructions

Follow your surgeon’s instructions carefully for optimal recovery. These may include:

  • Using prescription drugs to treat pain and avoid infection.
  • Wearing the compression garment as instructed to reduce swelling and support the chest.
  • Avoiding strenuous activities and heavy lifting for several weeks.
  • Keeping the surgical incisions clean and dry.
  • Keep up with your surgeon’s follow-up appointments so that you can discuss any concerns and track your progress.


Gynecomastia is classified into four grades based on severity, ranging from Grade I (minimal hypertrophy) to Grade IV (severe hypertrophy with ptosis). Each grade has specific characteristics and may require different treatment approaches, including non-surgical options such as monitoring and medication, as well as surgical options like liposuction and excision.

Consulting with an experienced asthetic or plastic surgeon like Dr. Sajal Halder at Orange Tree Clinic, is crucial for accurate diagnosis and personalized treatment planning. A healthcare professional can assess the severity of gynecomastia and recommend the most appropriate treatment options based on individual needs and preferences. Regular follow-up with a healthcare provider is essential to monitor progress, address any concerns, and ensure optimal outcomes.

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