When you are considering Gynecomastia Surgery in Jaipur, one of the first and most important steps in our consultation is diagnosis. Gynecomastia is not a uniform condition; its size, composition, and presentation differ dramatically between patients.
To create a precise, customised surgical plan, I use a standard grading system. Understanding which grade you fall into is the most important step in confirming your treatment plan, the cost of your surgery, and the benefits you can expect.
The Classification Challenge: Beyond Simple Size
While grading systems are essential, achieving an ideal classification system that guides surgeons precisely remains a challenge because objective assessment methods are generally absent from classification studies. This is largely because no single system is universally accepted.
The ideal classification system should be universal, surgically useful, and include a comprehensive set of clinically appropriate patient-related features, such as breast size, breast ptosis, tissue predominance, and skin redundancy. None of the current systems appears to fulfil all these criteria, necessitating a combined approach.
The Goal: There are many classification systems available, including Simon, Rohrich, and Wiesman. Some complex forms of gynecomastia do not match properly the existing classifications.
Modern Nuance: New systems, like the ultrasound-confirmed classification system, categorise types based on the most represented component (fat tissue, glandular tissue, or both) and the presence of ptosis, providing a more practical guide for surgeons.
The Simon Grades: A Foundational Roadmap
The most frequently referenced system is the Simon classification, which is based on surgical management after evaluating volume and skin surplus. It categorises patients into grades based on enlargement and skin excess:
| Simon Grade | Severity Description | Skin Characteristics |
| Grade I | Small enlargement – Puffy Nipple | No skin excess |
| Grade IIa | Moderate enlargement | No skin excess |
| Grade IIb | Moderate enlargement | Minor skin redundancy |
| Grade III | Marked enlargement | Marked skin redundancy |
Surgical Treatment Dictated by Grade
The severity grade dictates the required invasiveness and the necessary combination of techniques. A customised approach ensures that the surgical technique selected (liposuction, excision, or both) is the most effective and least invasive method for achieving a permanent, masculine chest contour.
Low Grades (I and IIa): Excision is Mandatory
These grades involve minor to moderate enlargement with minimal or no skin excess. Although liposuction may be used to contour the surrounding area, glandular excision is critical for preventing recurrence.
Liposuction Limitations: Liposuction alone usually will not fully correct a significant proportion of gynecomastia cases. This happens because the dense fibrous glandular tissue is resistant to suction. For glandular hypertrophy, Liposuction alone usually will not fully correct a significant proportion of gynecomastia cases.
The Permanent Solution: Even for Grade I, if true glandular tissue is present, surgical excision of glandular tissue is considered essential to cure gynecomastia.
Technique for Grades I/II: For patients without significant skin excess, the pull-through technique is a safe and effective surgical option. Studies show this procedure can be done effectively via a single incision without the use of drains.
High Grades (IIb, III, and IV): Managing Skin Redundancy
As the grade increases, the presence of significant skin redundancy (ptosis) and potential nipple displacement becomes the major technical challenge.
Defining Ptosis: Severity is often defined by the nipple-areola complex (NAC) position relative to the inframammary fold (IMF). Grade IV gynecomastia involves the NAC being more than 1 cm below the IMF.
Technique for Grade III
High-grade gynecomastia (Grade III) requires extensive tissue removal and often complex skin management. Techniques like the postero-inferior pedicle flap technique have been reported as promising for Grade III due to favourable functional and aesthetic results.
The Scar Trade-Off
For these advanced cases, the surgical plan must prioritise chest flatness and symmetry, which may increase scar visibility. The higher the grade of gynecomastia, the more complicated it is to form the male chest wall without leaving large, visible scars. The primary goal of surgery is the complete removal of the gland and excess skin, but for severe Grade III patients, the main surgical treatment is the free transplantation of the nipple–areola complex if the skin envelope cannot be adequately contracted.
Your Consultation in Jaipur
Your specific gynecomastia grade dictates the complexity and cost of your surgery. To get an accurate diagnosis and determine which grade defines your chest enlargement, I invite you to consult with me.
To book your personalised, confidential consultation, please reach out to my team at Kalpana Aesthetics.
- Call or WhatsApp: 7718183535
- Visit Us: Kalpana Aesthetics, 2nd Floor, Jaipur Hospital, Mahaveer Nagar, Tonk Road, Jaipur
Disclaimer: The information provided on this webpage is for educational purposes only and does not constitute medical advice. The gynecomastia grading system is a tool used by medical professionals to classify severity. Only a qualified, board-certified plastic surgeon can provide an accurate diagnosis after a physical examination. Individual results and surgical needs will vary.
English 
Hindi