Gynecomastia Type 7

Gynecomastia Type 7-Top of areola is below chest fold Extreme Sag

Definition
Extreme breast sag. The top of the areola is below the level of the chest fold.

Physical Exam

In Type 7 gynecomastia the top of the areola sags below the level of the chest fold.

Gynecomastia Type 7

Type 7 gynecomastia - male breast reduction from Orange County plastic surgeon Joseph T Cruise, MD

Notice that the top of areola is below the level of the chest fold.

TThe image below outlines the 7 types of gynecomastia. Types 1 is Puffy Nipple. Types 2-5 are determined by the chest angle. Types 6 and 7 are determined by the position of the nipple in relation to the chest fold.

Gynecomastia Types

The 7 types of gynecomastia. The horizontal line represents the level of the chest fold. Notice the progressive increase in skin laxity. This excess skin will change the type of surgery necessary to properly correct the problem

The purpose of categorizing gynecomastia is to determine what type of surgery is necessary to correct a given problem. Joseph T Cruise, MD has developed this classification system based on the extensive work he has done with gynecomastia patients. Other surgeons may use other methods.

Here is how the type of surgery changes depending on the gynecomastia type.

Type 1 – Incision at lower margin of areola
Type 2 – Incision at lower margin of areola
Type 3 – Incision at lower margin of areola or donut lift
Type 4 – Donut lift or anchor lift
Type 5 – Anchor lift
Type 6 – Anchor lift or free nipple graft
Type 7 – Free nipple graft

Unlike Type 6, Type 7 can not be treated with an anchor lift. The nipple and areola simply need to be elevated too much. The blood supply would not be adequate. A free nipple graft is when the nipple and areola are surgically removed and placed in its new position as a skin graft. This means that unlike the anchor lift, the free nipple graft is detached from the body completely and is repositioned as a skin graft.

Surgical implications

Liposuction
May or may not be useful to remove breast tissue depending on whether or not it is fatty or glandular. If patient is heavy, it may be used to flatten breast roll or decrease fatty deposits at chest margin.
Surgical removal of breast tissue
Surgical removal of breast tissue is often method of choice to ensure that all necessary breast tissue is removed. A significant advantage of the free nipple graft vs an anchor lift is that the surgeon does not need to leave extra volume to make sure the nipple gets a good blood supply. This can be a signficant problem as the tissue gathers like an accordian underneath the nipple. With a free nipple graft, all the breast tissue underneath the areola can be removed leaving a flatter, tighter chest.

Type 7 Gynecomastia

Before

After

Preferred incision/skin removal for gynecomastia types 1-7

Incision for Type 7 Gynecomastia

Free nipple graft

What are the pros and cons of a free nipple graft?

Pros

It has a relatively predictable blood supply that makes a type 6 and type 7 chest lift possible
It allows the surgeon to put the nipple/areola exactly where it needs to be
It allows for a flatter, tighter chest compared to the anchor lift

Cons
There likely will be partial or complete loss of nipple sensation.
There may or may not be a color change of the areola typically making it lighter
There remains a possibility that the areola will still not survive

‹‹ Type 6 Gynecomastia

Components of Gynecomastia ››