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How To Choose A Gynecomastia Surgery Doctor In Singapore

April 21, 2020
February 2, 2024

Dr Ivan Puah, Medical Director Amaris B. Clinic, believes that body sculpting procedures, which includes gynecomastia surgery, comprises 70% Art & 30% Science.

Table of Contents

Gynecomastia causes discomfort, pain and severe distress emotionally and physically. This medical condition is the most common male breast deformity affecting up to 65% of young and adult men globally.

Dr Ivan Puah, a liposuction and 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 four 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. Still, 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 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.

According to 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.

Causes of Gynecomastia: Idiopathic, Hormonal Imbalance, Puberty & Health Conditions

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. Age and massive weight loss can also be related to abnormal male breast development. However, the most frequent cause of gynecomastia is idiopathic.

When it does not regress spontaneously, Pubertal gynecomastia can result in enlargement of the glandular breast tissues causing an unfavourable appearance, which may lead to significant social and psychological impairment.

Gynecomastia Classifications

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. Mixed Gynecomastia: When both fat and glandular tissues are the cause of enlarged male breasts enlargement

Pseudogynecomastia Vs Gynecomastia: Know The Difference

Breast enlargements that only involve fat deposits without glandular tissue proliferation are classified as pseudogynecomastia, 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:

Exercise

• Gynecomastia: Does not respond to exercise or diet as it involves glandular and fat tissues

• Pseudogynecomastia: Regular exercise and a healthy diet may reduce excess fat build-up to a certain extent.

Non-invasive Fat Reduction Treatment

• Gynecomastia: Hardly respond, as it involves glandular and fat tissues

• Pseudogynecomastia: Non-invasive treatment may help somewhat, but this depends on individual anatomy and responsiveness.

Liposuction

• Gynecomastia: Liposuction is a great choice to remove fat permanently, but will not impact the glandular tissue.

• Pseudogynecomastia: Liposuction can successfully remove excess chest fat permanently.

Glandular Tissue Excision Surgery

• Gynecomastia: It can remove glandular tissue permanently.

• Pseudogynecomastia: Not necessary

Grades Of Gynecomastia

A classification from Simon, Hoffman and Kahn was adopted, known as the "Gynecomastia Scale" allows gynecomastia doctors to standardise the discussion of issues and treatment of gynecomastia. Gynecomastia (True and Mixed) is universally classified into Grades I, II, III and IV, according to the severity of the breast tissue enlargement.

Gynecomastia Grade I

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.

Gynecomastia Grade II

Grade IIA [Moderate male breast enlargement with no excess skin]
Grade IIB [Moderate male breast enlargement with excess skin]

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 individual's condition, loose skin may or may not be present clinically.

Gynecomastia Grade III

Grade III [Marked male breast enlargement with excess skin]

There will be moderate to significant breast enlargement with excess skin at this stage. 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 noticeable to others.

Gynecomastia Grade IV

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.

Gynecomastia Symptoms

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. Patients may also experience swelling, pain and even nipple discharge in one or both breasts.

How is Gynecomastia Diagnosed?

At Amaris B. Clinic, detailed clinical consultation and physical examination play an integral part in diagnosing your condition. Questions that Dr Ivan Puah may ask include:

• Medical history


• When and how long you've started noticing the signs of abnormal chest enlargement


• Any pain or discomfort accompanying the physical changes?


• Medications that you have taken or are currently taking


• Your diet, lifestyle and activity history


• Any surgery performed, injuries or any other health concerns that he needs to take note of


• Does the condition affect you while you go about with your daily activities and life?


The pinch and touch test done by Dr Ivan Puah determines if a patient has gynecomastia. A mound of fibrous and firm tissue is almost always a good indication. Besides that, he will also assess the patient for skin laxity and the presence of excess fat on the chest.

Who are the candidates for Gynecomastia Surgery in Singapore?

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 management.

The surgery suits patients with prominent bilateral breast enlargement or unilateral (one-sided) breast asymmetry. It is also suitable for patients with saggy breasts following massive weight loss and dieting and those with protruding and prominent areolas.

Gynecomastia Surgery: An Individualised  Approach At Amaris B. Clinic

Gynecomastia, 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 worldwide adopted different types of surgical techniques which play a significant role in the result for the patient.

"True gynecomastia is more commonly seen in extremely lean patients and bodybuilders who are on hormone supplements, making up 10%. Pseudogynecomastia, which refers to generalised fat deposits and is generally thought to be present in overweight patients, accounts for only 5%. Mixed gynecomastia, a combination of diffuse fat tissues and 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.

“Each gynecomastia case is unique and requires an individualised approach to ensure that not only the glandular tissues and fatty tissues are removed effectively, but also, the chest is meticulously sculpted and defined,” explains Dr Ivan Puah, who has received dedicated surgical training in gynecomastia in the USA.

Dr Ivan Puah developed his proprietary 360°GTD® technique to optimise patient results. During the procedure, an endoscopic-line incision, not bigger than 4mm, is first created to allow infiltration of anaesthetic fluid on the area to be treated. Through this incision, a 360°GTD® is performed carefully following the physiological disposition of the glandular tissues. Not only can the affected tissues be removed effectively, but scarring is also minimal, and the risks of haematoma are significantly reduced. Patients treated with 360°GTD® do not require suction drainage, which typically leaves ugly scars and increases the chances of infection post-op.

Dr Ivan Puah will perform fat removal with his MDC-Sculpt®️ Lipo Technique. He carefully removes stubborn fat with a specialised cannula, further contouring and sculpting the area for a more defined chest contour.

Pre-surgery Gynecomastia Surgery Preparation At Amaris B. Clinic

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 potential of increased bleeding and impairment of clotting. Abstain from alcohol at least 3 to 5 days before the surgery and stop smoking for several weeks ahead of time. Do completely shave your chest a day before the gynecomastia surgery.

On The Day Of Gynecomastia Surgery

The gynecomastia surgery is performed under local anaesthesia in an approved Day Surgery Center. 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.

What Are The Side Effects Of Gynecomastia Surgery?

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.

What To Expect Post-gynecomastia Surgery

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, and push-ups for two weeks, as these may hinder recovery.

A compression garment is essential in healing as it helps compress tissue swelling and assist in skin retraction. Do wear your compression garment at all times for 6 to 8 weeks.

What Aftercare Do You Provide After Gynecomastia Surgery?

At Amaris B. Clinic, aftercare significantly assists you with faster recovery and ensures 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.

How much does a Gynecomastia Surgery cost in Singapore?

Costs for gynecomastia surgery will vary between different practices, and the following factors will determine the price.

Experience of a gynecomastia surgery doctor

The experience of the gynecomastia surgery doctor who performs the procedure plays a significant role in the cost. A highly experienced gynecomastia doctor will receive more complex cases and have completed many cases, including correcting botched jobs. Therefore, the costs you are paying are for the experience and skills of the doctor.

The complexity of the Gynecomastia Case

The surgery's complexity depends on the grade of gynecomastia and the gland size, surrounding fat layers and skin laxity. At Amaris B. Clinic, the gynecomastia surgery is impeccably tailored to your clinical condition and the desired outcome.

What is the Success Rate of Gynecomastia Surgery?

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 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 Success Rate: Choosing A Gynecomastia Doctor In Singapore

Here are a few things to keep in mind when you are looking for a gynecomastia doctor in Singapore:

Experience of  a gynecomastia surgery doctor

• Find out what portion of the doctor's practice involves the treatment of male breast enlargement. Ask the doctor how frequently he performs this procedure. Is it weekly or just a handful of times a year?

• It is crucial to find a gynecomastia doctor who can consistently achieve a high satisfaction rate and great results.

• Before and After photos are a good indication of the gynecomastia success rate.

Assessment & Communication Skills

• The doctor should display confidence during the consultation and give you a clear and concise explanation of gynecomastia. He should be able to show you the different grades of gynecomastia that he has done and can answer your concerns.

Another essential pointer to find out the gynecomastia success rate of the doctor is to read reviews of patients who had their procedures done at the practice. That would indicate not only the results achieved but also many aspects of the practice which play an essential role in how your gynecomastia experience will turn out to be.

Check out the following :

  • 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?
  • Can they alleviate your concerns and worries about the procedure and make you feel at ease under their care?

Dr Ivan Puah: His Passion for Body Sculpting and Gynecomastia Surgery

Dr Ivan Puah, with his mentor, Dr Miguel Delgado, in the USA.

When searching for a 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 surgical experience, particularly in 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.

Dr Ivan Puah, Medical Director Amaris B. Clinic, believes that body sculpting procedures, which include gynecomastia surgery, comprise 70% Art and 30% Science. A doctor needs to be able to envision the result with an approach that best meets the desired results.

Reference

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