Gynecomastia is a condition characterized by the enlargement of breast tissue in males, and it can vary significantly in severity from one individual to another. Understanding the grading system is important in assessing and addressing this condition effectively.

There are four grades along the spectrum, and the gynecomastia plastic surgeons at the Boston Gynecomastia Specialists can help you gain valuable insight into creating treatment plans to suit your unique needs.

Grades of Gynecomastia

The severity of gynecomastia is categorized into stages ranging from grade 1 (mild or “puffy-nipples”) to grade 4 (severe). Each one of the stages is distinguished by specific characteristics. Treatment options and associated surgery costs also vary across the stages, with stage 4 requiring a different surgical approach compared to stage 1.

The four stages or grades of gynecomastia are:

  • Grade 1: small growth without excess skin
  • Grade 2: moderate growth without excess skin
  • Grade 3: moderate growth with excess skin
  • Grade 4: significant growth with excess skin

From a medical standpoint, it’s also crucial to understand that gynecomastia entails the overdevelopment of breast gland tissue. However, it’s common for excess breast fat tissue to be present as well. When the enlargement of the breast is solely due to excess fatty tissue, this is called pseudogynecomastia.

During a comprehensive gynecomastia procedure, both excess breast gland tissue and excess fat tissue can be addressed and removed.

Four Grades of Gynecomastia Overview

Let’s take a look in more detail at each stage of gynecomastia and what they entail.

Gynecomastia grade I

Grade 1 Gynecomastia: Small Growth without Excess Skin

Individuals with grade 1 gynecomastia experience minimal breast growth, often accompanied by nipple pain or tenderness. Swelling around the nipple is slight, and there is occasionally some discoloration. The nipple may also appear puffy and sensitive to touch.

Typically, stage 1 gynecomastia is not apparent when the individual is clothed. However, it may become noticeable in situations where the person is undressed, such as at the beach or swimming pool.

grade II Gynecomastia

Grade 2 Gynecomastia: Moderate Growth without Excess Skin

Grade 2 gynecomastia is characterized by a more pronounced enlargement of breast tissue that extends across the chest. This moderate growth may be noticeable even when the individual is clothed and becomes particularly prominent in bare-chested situations, which can cause embarrassment or distress.

In addition to enlarged breasts and tenderness can persist, further adding to the physical and emotional burden of the condition.

grade III Gynecomastia

Grade 3 Gynecomastia: Moderate Growth with Excess Skin

Advancing to grade 3 represents a substantial progression in gynecomastia, marked by significant breast tissue development and chest widening.

The enlarged breasts become notably pronounced, often visibly protruding through clothing. Moreover, excess skin becomes evident, resulting in a droopy appearance of the breasts.

Given the heightened visibility and physical changes associated with grade 3 gynecomastia, individuals may experience a significant impact on self-esteem and quality of life, prompting them to seek intervention.

grade 4 Gynecomastia

Grade 4 Gynecomastia: Significant Growth with Excess Skin

Grade 4 gynecomastia represents the most advanced stage of the condition, where breast enlargement is substantial and resembles female breasts in appearance.

The breasts become highly prominent, often dominating the individual’s physique, even when clothed. Excess skin becomes more noticeable, contributing to a fuller, drooping appearance of the breasts. Nipple size can also increase significantly, further emphasizing feminine characteristics.

Individuals dealing with grade 4 gynecomastia may experience profound emotional distress and encounter significant social challenges, necessitating comprehensive treatment and support.

Get in Touch With a Boston Gynecomastia Surgeon

At the Boston Gynecomastia Specialists, we understand the whole spectrum of gynecomastia and tailor our approach to address each patient’s unique needs

From the initial assessment to customized treatment strategies, our team is committed to delivering compassionate care and empowering individuals to regain their confidence.

If you are located around Boston or anywhere in New England and are experiencing any sort of gynecomastia symptoms, feel free to schedule a personalized consultation with our Boston gyno surgeon specialists. We are here to help guide you in your decision process and get you going in the right direction.


The Boston Gynecomastia Specialists is the premier Greater Boston Gynecomastia Center of excellence. We prioritize delivering exceptional care from your initial consultation to your recovery and beyond. We deeply value the trust you place in us and are committed to upholding the highest standards of patient care. Our team, led by Dr. Edwin Ishoo, a board-certified surgeon specializing in gynecomastia treatment, is devoted to achieving optimal surgical results for each individual. Recognizing that every person is unique, we personalize our approach to meet your specific needs. Whether you have questions or are ready to schedule your personalized in-person consultation, please don’t hesitate to contact the Boston Gynecomastia Specialists today. We’re here to support you every step of the way!

Boston Gynecomastia Specialists
1260 Cambridge st
Cambridge, MA 02139
(888) 380-322