April 4, 2022
Dr Ivan Puah Boon Kwang, Medical Director Amaris B. Clinic, believes that body sculpting procedures, which includes gynecomastia surgery, comprises 70% Art and 30% Science.
Gynecomastia causes discomfort, pain and severe distress emotionally and physically. This medical condition is the most common male breast deformity that can affect up to 65% of young and adult men globally.
Dr Ivan Puah, a gynecomastia surgery doctor in Singapore at Amaris B. Clinic with more than 20 years of clinical practice, shares that it's pretty common in Singapore too. Gynecomastia is commonly seen during the three phases in the age distribution curve in males - the neonatal period (the first 4 weeks of a child's life), pubertal period (Between the age of 12 to 16) and adulthood (20 years and above). He shares, "The prevalence of asymptomatic gynecomastia in neonates is estimated to be between 60% and 90%. The second physiological peak of occurrence is at puberty between the ages of 10 and 16 years."
"In fact, approximately 50% to 60% of adolescents have been estimated to have gynecomastia. Fortunately, most cases in the above 2 groups regress spontaneously, but then it seems to return, with the last peak in incidence of gynecomastia seen in men 50 to 85 years of age, with a reported prevalence of up to 70%", reveals Dr Puah.
Gynecomastia is a real medical problem, albeit one not openly discussed mainly among sufferers. Understandably so as it can be an embarrassing issue although it should not be an excuse for not seeking help for gynecomastia causes real pain and discomfort. That may be why, per a new report from the American Society of Plastic Surgeons, male breast reduction surgeries are on the rise among men. According to the report, male breast reduction surgeries have increased by 30% over the past five years, more than any other plastic surgery procedure for men.
The condition is equally prevalent among adults and youths (teenagers included). Hormonal imbalance, genetics and in some, the use of anabolic steroids, may lead to the development of gynecomastia. Gynecomastia may also occur as a side effect from prolonged use of certain medications due to other medical conditions. Contributing factors such as age and massive weight loss can also be related to abnormal male breasts development. However, the most frequent cause of gynecomastia is actually idiopathic.
Pubertal gynecomastia, when it does not regress spontaneously, can result in enlargement of the glandular breast tissues causing an unfavourable appearance, which may lead to significant social and psychological impairment.
The most used classification is based on the tissue components involved in gynecomastia:
1. True Gynecomastia: When only glandular tissue is the cause of male breast enlargement
2. Pseudogynecomastia: When it is due to only fat deposits without the involvement of glandular tissues
3. Mixed Gynecomastia: When both fat and glandular tissues are the cause of enlarged male breasts enlargement
Breast enlargements that only involve fat deposits without glandular tissue proliferation are classified as pseudogynecomastia, which is also clinically known as lipomastia.
Individuals who suffer from pseudogynecomastia can embark on a weight loss and exercise program as a first-line treatment. Liposuction is recommended when the fat tissues do not respond to exercise or dieting.
Here's a look at the main differences in the effects of the actions taken between gynecomastia and pseudogynecomastia:
• Gynecomastia: Minor effect. Exercise may have an impact on excess fat, but it will not have any effect on the glandular tissue.
• Pseudogynecomastia: Minor to significant effect. Regular exercise and a healthy diet may reduce excess fat build-up.
• Gynecomastia: Minor effect. Exercise may have an impact on excess fat, but it will not have any effect on the glandular tissue.
• Pseudogynecomastia: Minor effect. This may help to reduce excess fat. However, this greatly depends on individual anatomy and responsiveness.
• Gynecomastia: Minor to moderate effect. Liposuction is a great choice to remove fat permanently, but this type of surgery will not have any impact on the glandular tissue.
• Pseudogynecomastia: Significant effect. Liposuction can successfully remove fat pockets permanently.
• Gynecomastia: Significant effect. Gynecomastia surgery can also reshape the appearance.
• Pseudogynecomastia: Unnecessary procedure to undergo.
A classification from Simon, Hoffman and Kahn was adopted and is known as the "Gynecomastia Scale". This scale enables gynecomastia doctors to standardise the discussion of issues and treatment of gynecomastia. Gynecomastia (True and Mixed) is universally classified into Grade I, II, III and IV, according to the severity of the breast tissue enlargement.
Grade I gynecomastia is characterised by minor breast enlargement with a small localised tissue around the areola or surrounding nipple area. At this stage, it is generally less noticeable with clothing but can be evident when undressed. Gynecomastia surgery can be an effective solution if it persists. Generally, the outcome of gynecomastia surgery in treating Grade I gynecomastia is very successful.
Grade II gynecomastia is most commonly seen; it involves mild to moderate male breast enlargement, which expands up to the width of the chest. Depending on the condition of the individual, loose skin may or may not be present clinically.
At this stage, there will be moderate to significant breast enlargement with the presence of excess skin. As the enlarged male breast tissue extends further into the breast zone, the male chest starts to look slightly like the feminine breasts and at this stage, the condition becomes clearly noticeable by others.
Grade IV gynecomastia is a significant breast enlargement further aggravated with substantial excess skin. This grade is severe and highly visible, giving the appearance of a feminine breast appearance. Grade II to Grade IV gynecomastia will require fat removal in the form of VASERLIpo and surgical excision of glandular tissues.
The main symptom for men who are suffering from gynecomastia is the appearance of a feminised breast. Specific signs of this condition include enlarged breast tissue and tenderness. In some cases, patients may also experience swelling, pain and even nipple discharge in one or both of the breasts.
Suspect you may have gynecomastia? In true gynecomastia, glandular tissue may develop in one or both breasts. This tissue may be located directly behind the nipple. To check for the symptom, gently feel your breast with your fingertips. Should you suffer from true gynecomastia, you should feel a soft, rubbery lump in one or both breasts.
True gynecomastia may occur in just one breast or both breasts at a go. And with the size of the lump varying, it may not be the same in both breasts.
Gynecomastia may cause your breasts to be tender and sore, especially when you touch or press on them. If your breasts are causing you a significant amount of pain or discomfort, it is advisable to make an appointment with your doctor right away.
At Amaris B. Clinic, detailed clinical consultation and physical examination play an integral part in diagnosing your condition. Dr Ivan Puah will conduct a series of physical assessment and questions while establishing a full report on your concerns. Questions that Dr Ivan Puah may ask include :
Gynecomastia surgery is recommended for those suffering from gynecomastia for longer than 12 months, and those whose condition does not resolve independently or with other means of management.
The surgery is suitable for patients who have prominent bilateral breasts enlargement or unilateral (one-sided) breasts asymmetry. It is also suitable for patients with saggy breasts following massive weight loss and dieting and those with protruding and prominent areolas.
Gynecomastia, or commonly known as man boobs, is a medical condition that can cause severe emotional and physical distress in men. Over the years, many gynecomastia doctors around the world adopted different types of surgical techniques which play a significant role in the end result for the patient.
"True gynecomastia is more commonly seen in extremely lean patients, and bodybuilders who are on hormone supplements and that makes up 10%. Pseudogynecomastia, which refers to generalised fat deposits and generally thought to be present in overweight patients, accounts for only 5%. Mixed gynecomastia, a combination of both diffuse fat tissues enlargement of the breasts with subareolar fibrous components, is very common. It accounts for almost 85% of patients seen at my practice," explains Dr Ivan Puah.
Having undergone dedicated training in gynecomastia surgery in the USA, Dr Ivan Puah further refined his surgical skills and developed a 360° Glandular Tissue Dissection (360°GTD®) technique.
Endoscopic-line incision, not bigger than 4mm, is first created to allow infiltration of anaesthetic fluid on the area to be treated. By creating endoscopic-like incisions, Dr Ivan Puah effectively reduces the invasiveness of the procedure, thereby improving the cosmetic outcome. Through this incision, a 360°GTD® is then performed carefully following the physiological disposition of the glandular tissues.
VASER Lipo is performed on those with fatty tissues enlargement of the breasts. The VASER probe delivers ultrasonic sound wave energy which breaks down the fat cells efficiently while leaving the surrounding connective tissues, blood vessels and nerves relatively undisrupted. Following that, Dr Ivan Puah carefully suctions the liquefied fat with a specialised VASER cannula and further contours the chest, leaving the area with a sculpted look. Furthermore, VASER Lipo stimulates collagen production for better skin tightening.
"Based on my experience, each gynecomastia case is unique, and the surgical approach should not conform to one-type-fits-all. During the assessment, I'll carefully consider the degree of the gynecomastia, and glandular tissue-to-fat ratio and thereafter propose an individualised approach for the patient. Ultimately, my aim is to reduce breast size by removing fibrous and painful tissue and/or fat tissue to restore a natural-looking masculine body shape, with the smallest possible incision," says Dr Ivan Puah.
4D Chest RemodellingⓇ developed by Dr Ivan Puah is a customised and more complex treatment modality especially planned for those whose ultimate objective is to achieve a flat, sculpted chest with tightened skin and improved nipple appearance. It involves Dr Ivan Puah performing the high-definition body sculpting on the patient to remove fat and 360° GTD® to excise the glandular tissues, further sculpt and shape the chest and correcting disproportionately shaped nipples.
Dr Ivan Puah and team will give you a list of pre-op instructions to follow. You must follow the do's and don'ts to minimise the risks of possible surgical complications, including stopping or refraining from taking certain drugs/medications. Vitamin E and Vitamin C should be stopped for 1-week pre-surgery due to the potentials of increased bleeding and impairment of clotting.
Abstain from alcohol at least 3 to 5 days before the surgery and to stop smoking for several weeks ahead of time. Do completely shave your chest a day before the gynecomastia surgery.
The gynecomastia surgery may take 1 to 2 hours and is performed under local anaesthesia. You may want to arrange for a family member/friend to pick you up after the procedure. Arrive at the facility with an empty stomach and nothing by mouth for 8 hours pre-op. Do not drink coffee or tea on the day of the procedure.
Post-procedure swelling, bruising, and numbness are to be expected and will improve with time. It is part of the healing process as with other surgical procedures. During the consultation, you will be informed of what to expect to alleviate any concerns.
After your gynecomastia surgery, do remember to take it easy for a while. Gynecomastia surgery performed by Dr Ivan Puah causes minimal disruption to your daily activities. However, it is advisable to avoid water-based activities and strenuous exercises such as heavy lifting, bench presses, push-ups for 2 weeks as these may hinder the recovery process.
A compression garment is essential in the healing process as it helps with the swelling, skin contraction and comfort. Do wear your compression garment at all times for 6 to 8 weeks.
At Amaris B. Clinic, aftercare plays a significant role not only to assist you with faster recovery but also to ensure optimum results. After your gynecomastia surgery, we offer a bespoke aftercare program designed to help with the healing process. We carefully assess your clinical condition and tailor the treatment to your expectations.
Costs for gynecomastia surgery will vary between different practices, and the following factors will go into determining the cost.
The experience of the gynecomastia surgery doctor who performs the procedure plays a significant role in the costing. A highly experienced gynecomastia doctor will receive more complex cases and have performed many cases, including that of correction cases that were performed by others. Therefore, the costs that you are paying for is for the experience and skills of the doctor.
The complexity of the surgery is dependent on the "Grade of Gynecomastia" and also the gland size, surrounding fat layers and skin laxity. At Amaris B. Clinic, the gynecomastia surgery is impeccably tailored to your clinical condition and desired outcome.
Gynecomastia surgery yields a high success rate once the enlarged glandular tissue and/or excess fat tissues are removed. To minimise the risks of post-surgical complications and to achieve the optimal results post-surgery, the patient is advised to follow closely and adhere to the pre-operative instructions and post-treatment care program as planned by Dr Ivan Puah.
Gynecomastia surgery does significantly address the issue of enlarged male breasts, but it is advisable to not be too hasty in seeking help. News of botched surgeries, including of the cosmetic kind are aplenty and serves as reminders to keep a steady head notably during adversity. Here are a few things to keep in mind when you are looking for a gynecomastia doctor in Singapore:
• Find out what portion of the doctor's practice involves the treatment of male breasts enlargement. Ask the doctor how frequently he performs this procedure, is it weekly or just a handful of times a year as that will determine the results of your procedure.
• It is crucial to find a gynecomastia doctor who not only performs the procedure regularly but also one who can consistently achieve a high satisfaction rate and great results.
• Before and After photos are a good indication of the gynecomastia success rate performed by the doctor as it is often a direct reflection of their experience with the procedure.
• The doctor should display confidence during the consultation and give you a clear and concise explanation of gynecomastia, able to show you before and after photos of cases that he has performed and answer your concerns.
• The doctor should be able to, after assessing your clinical condition and medical history, give you a simple, uncomplicated explanation as to how and why he is recommending a particular surgical approach for your body type. Does the approach address your concerns, for example, loose skin, crease beneath your breast, puffy nipples or diffuse enlargement?
Another important pointer to find out the gynecomastia success rate of the doctor is to read up reviews of patients who had their procedures done at the practice. That would give an indication on not only the results achieved but also on many aspects of the practice which play an essential role in how your gynecomastia experience will turn out to be.
Factors such as the experience of the doctor's medical support team. How long have they been assisting the doctor with the procedure? Are they able to render advice to you timely? Are they professional, confident and knowledgeable when answering your questions? Are they able to alleviate your concerns and worries on the procedure and make you feel at ease under their care?
When searching for gynecomastia doctor in Singapore, there are a few more things to bear as you run through the search list:
• Ensure that the gynecomastia surgery doctor is licensed to perform liposuction by the Ministry of Health, Singapore
• Having a wealth of surgical experience in particular that of male breast reduction surgery. A sense of artistic skills is also a welcomed trait in a doctor so that he can relay realistic expectations and help realise results.
• Excellent communication skills are equally important, as a doctor needs to understand a patient's concerns to help alleviate them. He should be able to address any queries and worries with confidence, based on his experience.
Dr Ivan Puah, Medical Director Amaris B. Clinic, believes that body sculpting procedures, which includes gynecomastia surgery, comprises 70% Art and 30% Science. A doctor needs to be able to envision the end result with an approach that best meets the desired results.
Dr Ivan Puah is accredited by the Ministry of Health, Singapore to perform liposuction and has performed many gynecomastia surgeries for more than 15 years. He has received various liposuction and body sculpting training overseas. He is a certified VASER physician with vast experience in performing VASERLipo, VASER Hi-Def and body contouring correction surgeries since 2008. He is the only doctor in Asia to receive dedicated surgical training in gynecomastia surgery in the USA under gynecomastia expert, Dr Miguel Delgado.
The advancement in technology has and continues to open up new treatment methods to address the myriad of issues of both the health and cosmetic kind.
In the past, men who suffer from gynecomastia may have to live with the condition forever. Today, the path to a remedy is just a matter of a click or two away (on the internet).
Still, the onus is on the individual to do their due research and engage a qualified, and experienced doctor.