Redefining Gynecomastia Grading Using Anthropometric Parameters and Surgical Algorithm for Gynecomastia: A...

Gynecomastia is a benign enlargement of male breast tissue. Traditional classifications, such as those by Simon and Rohrich, rely mainly on clinical judgment, leading to interobserver variability and surgical planning. A need exists for a measurable, reproducible objective grading method. This study proposes a gynecomastia classification system integrating anthropometric parameters such as nipple-to-pectoralis major distance and chest circumference difference. These objective measures aim to enhance grading reliability and surgical planning.

A total of 134 patients who underwent gynecomastia correction between January and December 2024 were analyzed. Statistical analysis was performed using R software version 4.2. Receiver operating characteristic analysis determined the area under the curve, optimal cutoff points, and sensitivity and specificity.

In our modification, we assess severity using 2 objective measurements: the nipple-to-pectoralis major muscle distance and the difference in chest circumference between the nipple level and the inframammary fold. Grade 1 corresponds to a distance of less than 2 cm and a circumference difference of less than 3 inches; grade 2, 2-4 cm and 3-4 inches; grade 3, 4-6 cm and 4-6 inches; and grade 4, more than 6 cm and more than 6 inches. These parameters serve as indirect yet reliable indicators of skin redundancy and breast size.

This grading system improves diagnostic accuracy and reproducibility in gynecomastia evaluation. It offers an objective, standardized framework that enhances communication and predictability of outcomes.