Types of Gynecomastia Austin | Austin Gynecomastia Center

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Gynecomastia is defined and diagnosed by the appearance of female-like looking breasts in a male. In order to have a female-like looking chest, it is necessary to have excess underlying chest tissue. The “ideal” male chest has an even layer of thin underlying subcutaneous tissue with small, flat nipple-areola complexes.

The appearance of widened areolas and puffy nipples results from gynecomastia tissue below. The common feature of ALL gynecomastia cases is an imbalance in the sex hormones estrogen and testosterone. Interestingly enough, the cause of gynecomastia has little or nothing to do with the treatment of the condition. No matter how you developed gynecomastia, your treatment will almost always be the same (at least at the Austin Gynecomastia Center).

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The Gynecomastia Zone Map

Zone Map of the Male Chest

Gynecomastia diagnosis is about how, but also about where. After thousands of gynecomastia surgery patients, Dr. Caridi developed and published his gynecomastia zone classification system that helps in the diagnosis and treat gynecomastia and improves doctor-patient communication. For further information see Dr. Caridi’s publication in the Journal of the American Society of Plastic Surgeons. AGC uses this simple and effective tool when evaluating patients at Austin Gynecomastia Center and through our Online Consultation service.

Zone 0 is the area immediately behind the nipple-areola complex. This is commonly glandular tissue and is responsible for the “puffy nipple” appearance.

Zone 1 is the anterior chest area that looks like a horizontal ellipse. This Zone includes Zone 0, the most commonly affected area in gynecomastia, and creates the female breast appearance. Fullness in Zone 1 obscures the “hockey stick” outline of the pectoral muscle, which is critical for a manly appearance. Treatment of this area is responsible for the definition and outline of the chest muscle desired by patients.

Zone 2 is the area to the side of the chest and under the arm. This fullness is seen in patients carrying too much weight and those who have genetically inherited excess fatty tissue. This results in lateral chest fullness that takes away from the V cut chest appearance.

Zone 3 is the area at the apex of the crease of the armpit. Fat in this area bulges from the lateral border of the pectoralis muscle. After treatment, the muscle looks sculpted and well-defined.

Zone 4 is located at the bottom of the chest and looks like a banana. This is seen in about 10% of cases. It may be a part of a patient’s normal anatomy, but is also often associated with being overweight. It’s made more noticeable by the formation of a crease from a long history of flexion at the chest level to hide gynecomastia.

Zones 0 and 1 have true gynecomastia tissue present. Zones 2-4 only have fat and are included in chest contouring treatment to ensure the best, most symmetrical, natural-looking and masculine chest for each patient.

Types of Gynecomastia

Easy Ways to Identify Different Types of Gynecomastia

The easiest way to identify different types of gynecomastia is by the patients who share a common experience in terms of the hormone imbalance that caused their gynecomastia. In his decades of research and work with gynecomastia patients, Dr. Robert Caridi has learned to break down these types of gynecomastia into five different groups: Puberty Gynecomastia, Bodybuilder’s Gynecomastia, Obesity Gynecomastia, Senior Gynecomastia, and Medical Gynecomastia.

Puberty Gynecomastia

The most common presentation of gynecomastia is someone who developed it at puberty, and it persisted throughout their life. This is often referred to as idiopathic gynecomastia, puberty gynecomastia, adolescent gynecomastia, or, “I’ve had gynecomastia my entire life.”

Additional Reading

Young boys go through a time in their life when their hormones change causing secondary sex characteristics like hair growth, a deeper voice and pimples. It also typically causes tissue growth behind the nipples that can become larger and tender BUT usually disappears after a year. Unfortunately, in some cases, there is persistence of this tissue (even growth) that eventually becomes established gynecomastia.

Bodybuilder’s Gynecomastia

The next largest category of gynecomastia patients is relatively new—probably the past 15 years in the making. This is the Bodybuilder/Fitness/Anti-Aging category. This group has grown in size because of the proliferation of the use of steroids, hormones, supplements, and other substances used to enhance fitness and possibly turn back the clock of time.

Additional Reading

Gynecomastia develops after using substances that cause a disturbance in the sex hormone balance (even short term) with the growth in gynecomastia tissue. They can tell you about a time in their lives when they took substances and the development of gynecomastia shortly afterward. Many would like to continue to take substances without the fear of recurrent gynecomastia after treatment.

Gynecomastia and Obesity

The third category is caused by obesity—overweight men who are well outside their ideal Body Mass Index (BMI). We are in the midst of a nationwide obesity epidemic with up to 60 percent of Americans considered overweight. It seems the Covid 19 pandemic has contributed to obesity significantly. We know that weight gain deposits fatty tissue throughout the body, including the male chest.

Additional Reading

The excess fat in the area of the hormonally sensitive tissue under the nipple-areola complexes causes an imbalance of the sex hormones, and this causes the growth of gynecomastia tissue. Unfortunately, weight loss does not result in the disappearance of gynecomastia as the tissue has become fibrotic and unresponsive to anything but surgery to remove the tissue. If there is another big reason not to gain too much weight, it is the fear that you will develop gynecomastia. It should be known that this group of patients often have to confront the issue of skin removal treatment with scars across the chest at a much higher frequency because the stretched skin loses its elasticity. There is a convincing relationship between weight gain and gynecomastia.

Senior Gynecomastia

Gynecomastia in older men makes up the fourth group of men presenting with gynecomastia. This group is not new, but it really hasn’t gotten much attention. As men age, they develop the same type of hormone imbalance that causes the development of gynecomastia tissue as the natural hormone levels begin to reach “retirement.” Add in the loss of skin elasticity with age and the tendency for humans in general to gain weight, and you have the perfect storm for a bigger, sagging chest.

Medical Gynecomastia

The fifth most common category is men who take certain medications or have medical problems that lead to gynecomastia. Although many drugs have been implicated in the development of gynecomastia, only a few are definitively associated. The list includes spironolactone, ketoconazole, cimetidine, estrogens, anti-androgens, and others. Risperidone is likely to be associated with gynecomastia. Medical conditions such as Klinefelter syndrome, liver and kidney conditions, hormone disorders (pituitary insufficiency), and others are associated with gynecomastia. The term “hypogonadism” refers to the condition of insufficient testosterone.

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Find the answers and solutions you need at Austin Gynecomastia Center

Before & Afters

The Gynecomastia Zone Map

Types of Gynecomastia

Puberty Gynecomastia

Additional Reading

Bodybuilder’s Gynecomastia

Additional Reading

Gynecomastia and Obesity

Additional Reading

Senior Gynecomastia

Medical Gynecomastia

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