Gynaecomastia

Clinical criteria[10]Nuttall FQ. Gynecomastia as a physical finding in normal men. J Clin Endocrinol Metab. 1979 Feb;48(2):338-40. http://www.ncbi.nlm.nih.gov/pubmed/429488?tool=bestpractice.com

Three criteria are used clinically:

• Breast tissue greater than 2 cm in diameter in adults (smaller dimensions are difficult to measure accurately)

• Breast tissue extending beyond the nipple area (minimum detectable diameter approximately 0.5 cm)

• Breast tissue appearance similar to Tanner breast stage B3 for female adolescents (mean nipple diameter 3 to 4 mm; breast tissue raised but areola and breast tissue have a single contour).

American Society of Plastic Surgeons (ASPS) gynaecomastia scale

The ASPS has classified gynaecomastia based on clinical appearance (using a scale adapted from the McKinney, and the Simon, Hoffman, and Kahn scales).[2]Simon BE, Hoffman S, Kahn S. Classification and surgical correction of gynecomastia. Plast Reconstr Surg. 1973 Jan;51(1):48-52. http://www.ncbi.nlm.nih.gov/pubmed/4687568?tool=bestpractice.com [71]Executive Committee of American Society of Plastic Surgeons. Practice parameters: gynecomastia. Feb 2004 [internet publication]. https://www.plasticsurgery.org/Documents/medical-professionals/health-policy/evidence-practice/Gynecomastia-PP.pdf

• Grade I: small breast enlargement with localised button of tissue that is concentrated around the areola.

• Grade II: moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest.

• Grade III: moderate breast enlargement exceeding areola boundaries with edges that are distinct from the chest with skin redundancy present.

• Grade IV: marked breast enlargement with skin redundancy and feminisation of the breast.