I have devised a Gynecomastia Zone Classification System system at the Austin Gynecomastia Center that has been very useful in communicating with and treating gynecomastia patients. After my first 500 cases of gynecomastia, it became clear to me that there are very consistent zones of the male chest that can show signs of fullness, yet not all patients have the same combination of these zones. Developing this classification system has allowed my patients to effectively communicate the areas of concern and has allowed me to communicate the areas targeted for treatment.
Zone 0 or “ground zero” is the area immediately beneath the nipple-areola complex. This is the epicenter of the growth of all gynecomastia because it is the location of glandular tissue in both men and women. This is also the zone in which fullness causes puffy nipples. If the tissue is not effectively treated in this area, puffy nipples will continue after treatment. This area is the typical “tip of the iceberg” in larger cases of gynecomastia.
Zone 1, the frontal area of the chest that includes Zone 0, is typically connected to the the top of a mountain that spreads out from Zone 0, and can cause significant fullness in this Zone 1. The most common presentation of gynecomastia is Zone 1 fullness.
Zone 2 is the area lateral to the frontal chest or under the arms. The tissue here is fatty and is not gynecomastia tissue. The most common cause of fullness here is simply being overweight. The second most common cause is genetics. This unflattering fullness under the arms appears as if you have wings outside the chest area —when you move your arms along your body you will rub up against this area.
Zone 3 is what I call the “axillary apex.” This is a discrete region just at the crease where your arm meets your chest. It is not uncommon to have exaggerated fullness that looks like a bulge on the side of your chest muscle. It is round and not linear, hence it looks out of place in men.
Zone 4 is the area beneath the chest crease. Enlargement of this zone is typically seen in patients who are overweight. This area is more closely related to the chest rather than the upper part of the abdomen.
When describing a patient’s gynecomastia, he can have Zone 0, Zone 1, Zones 1 and 2, Zones 1 and 3 or all Zones. Effective communication about Zones helps me know your areas of concern, and helps me inform you about the areas of proposed treatment.
Zone 1 treatment best describes gynecomastia treatment, while the additional Zones move treatment into the “chest contouring” category. In other words, if I were to treat the true gynecomastia alone in Zone 1, and not treat the surrounding Zones, the result would appear unnatural or unbalanced. I treat the other zones so that the best result is achieved.
Treating Zones other than 1 increases the length of your procedure and will result in more soreness afterwards. The biggest problem with treatment outside Zone 1 is related to discomfort wearing the compression garment that often digs into the armpit area. Mondor’s, or superficial inflammation of the chest veins, is also more common when I treat the underarm area. This is a benign, self-limiting condition that resolves itself within several weeks.
If you are unfamiliar with my Zone Classification, I suggest that you check out a cool interactive feature on my website that will make it crystal clear. We want effective communication so that you can achieve your desired result. I hope that you find my classification system helpful. No matter who you prefer to treat your gynecomastia, keep this Zone system in mind so you and your surgeon are on the same page.