title: Gynecomastia Classification for Surgical Management: A Systematic Review and Novel Classification System.
abstract: BACKGROUND
  Gynecomastia is a common deformity of the male breast, where certain cases warrant surgical management. There are several surgical options, which vary depending on the breast characteristics. To guide surgical management, several classification systems for gynecomastia have been proposed.
  
  
  METHODS
  A systematic review was performed to (1) identify all classification systems for the surgical management of gynecomastia, and (2) determine the adequacy of these classification systems to appropriately categorize the condition for surgical decision-making.
  
  
  RESULTS
  The search yielded 1012 articles, and 11 articles were included in the review. Eleven classification systems in total were ascertained, and a total of 10 unique features were identified: (1) breast size, (2) skin redundancy, (3) breast ptosis, (4) tissue predominance, (5) upper abdominal laxity, (6) breast tuberosity, (7) nipple malposition, (8) chest shape, (9) absence of sternal notch, and (10) breast skin elasticity. On average, classification systems included two or three of these features. Breast size and ptosis were the most commonly included features.
  
  
  CONCLUSIONS
  Based on their review of the current classification systems, the authors believe the ideal classification system should be universal and cater to all causes of gynecomastia; be surgically useful and easy to use; and should 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 classification systems appears to fulfill these criteria.
authors.affiliation: Ottawa and Hamilton, Ontario, Canada.|From the Department of Medicine, Faculty of Medicine, University of Ottawa; and the Division of Plastic Surgery and the Surgical Outcomes Research Center, Department of Surgery, and the Departments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University.
authors.forename: Daniel
authors.initials: D
authors.lastname: Waltho
authors.affiliation: Ottawa and Hamilton, Ontario, Canada.|From the Department of Medicine, Faculty of Medicine, University of Ottawa; and the Division of Plastic Surgery and the Surgical Outcomes Research Center, Department of Surgery, and the Departments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Hatchell
authors.affiliation: Ottawa and Hamilton, Ontario, Canada.|From the Department of Medicine, Faculty of Medicine, University of Ottawa; and the Division of Plastic Surgery and the Surgical Outcomes Research Center, Department of Surgery, and the Departments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University.
authors.forename: Achilleas
authors.initials: A
authors.lastname: Thoma
mesh_terms: D006177:Gynecomastia / Q000145:classification* / Q000601:surgery*; D006801:Humans; D008297:Male; D016462:Mammaplasty / Q000379:methods; D008408:Mastectomy / Q000379:methods