When thinking about the different stages or types of gynecomastia, grade one is the first that men will notice. It may be preceded by some itching around the nipple area, or ‘jutting out’ of the nipple, but this is the first noticeable change most men see. Grade one gynecomastia can be felt as a firm or rubbery nodule behind the nipple. This does not spread beyond the edges of the pink ‘areola’ on the chest wall. It is usually found on both sides, and there may be some discomfort, but is not usually acutely painful. Many men may be happy to live with this degree of gynecomastia, although for some it may be very distressing. If the cause of breast enlargement continues, the gynecomastia may progress through to other grades, although for some men grade one is as large as the swelling becomes. Doctors may be reluctant to consider treatment for grade one gynecomastia and simply suggest diet and exercise if this is needed. Many surgeons would advise against surgery as the swelling is small so the possible benefits are limited.