The 3 grades of gynecomastia include: Grade 1: is defined as a small degree of breast tissue enlargement with a localized area of swollen, excess breast tissue under the nipple or surrounding the areola. Grade 2: Defined as mild to moderate breast tissue enlargement. This can expand up the width of the chest and give the appearance of small male breasts. Grade 3: Defined as moderate to significant breast enlargement, expanding the chest’s width with excess skin.