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November 24, 2025
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An enlarged male breast can be caused by two conditions: gynecomastia and pseudogynecomastia.
Pseudogynecomastia is characterised by excess fat accumulation in the male chest, whereas gynecomastia is a medical condition marked by enlarged glandular tissue. In most cases of mixed gynecomastia, the chest is characterised by a combination of enlarged glandular tissue and excess fat.
Symptoms of pseudogynecomastia (fake gynecomastia)
- Enlarged breasts: Resulted from the accumulation of fat in the chest.
- Soft, pliable tissue: The enlarged chest should feel like soft fat, not a firm, disc-like lump of glandular tissue
- No pain or tenderness: Unlike true gynecomastia, there is usually no pain, soreness, or sensitivity in the nipples.
- No nipple discharge: No fluid should be coming from the nipples.
Gynecomastia, a medical condition in the male chest that can cause literal pain
Gynecomastia is a prevalent medical condition in men, causing 50% to 70% of the male population in the world to suffer from enlarged male breasts.
In Singapore, an estimate of 50% to 60% of teenage boys suffer from this condition, while almost 65% of adult men between 27 and 92 have some degree of gynecomastia.
The growth of the glandular tissue bears a unifying shape of a head, body, and tail.
The head of the gland is shaped like a half-circle and is located closer to the sternum. Most of the glandular tissue is found in the body, which is just behind the nipple area.
The tail of the gland narrows as it moves toward the outer side, near where the pectoralis major muscle attaches to the arm bone (humerus) [1].
Patients with more severe gynecomastia also encounter enlarged areola, puffy or longer nipples, redundant skin, and even nipple-areola ptosis, where the nipple and areola move below their natural position [2].
There are also other symptoms of gynecomastia that patients who suspect they may be suffering from gynecomastia would want to take heed of besides swelling and tenderness.
Case Study: Gynecomastia with left breast abscess
In the USA, a 44-year-old man arrived in the Emergency Department with a left breast abscess. He noticed symptoms about 9 days ago that started with redness, swelling, and pain in the left nipple area [4].
Over time, the symptoms worsened, leading to increased swelling, pain, and some non-smelly white discharge from the nipple. He had similar issues 3 months ago and also 1.5 to 2 years earlier in the same spot [4].
Case Study: Gynecomastia can cause puffy nipples
Puffy nipples are a common sign of gynecomastia. It is usually accompanied by tenderness or swelling in the area of the areola. The enlarged glandular tissue may extend outward, leading to a semicircular or dome-shaped areola and nipples that appear more prominent and even larger in some cases.
After diagnosing gynecomastia, it's essential to address any underlying causes. If no cause is found, it's usually sufficient to monitor the condition. If the gynecomastia is severe and has started recently, doctors may try medical treatment. As a last resort, surgery can be done to remove the excess glandular tissue [3].
“Preventing gynecomastia is challenging because it is primarily caused by hormonal imbalances in individuals with physiological gynecomastia.
It is not easily preventable through specific measures, and treatment options may vary depending on the underlying cause,” shares Dr Ivan Puah, a MOH-accredited liposuction doctor who has more than 20 years of gynecomastia surgery experience in Singapore.
How Dr Puah personalises men's chest contouring for each patient and case
For gynecomastia
Surgical plan: Gynecomastia & Nipple Reduction Surgery with Dr Puah's novel method called 360° Glandular Tissue Dissection (GTD®) Technique.
Each gynecomastia case is unique, and so is every surgical plan.
By combining gynecomastia and nipple reduction surgery with Dr Puah's novel method, called 360° Glandular Tissue Dissection (GTD) Technique, he can achieve a masculine chest contour for each patient.
360° GTD® technique overview
- Small incision: A single, small endoscopic-line incision (under 4mm) is made, typically low on the areola, to allow for both the tissue dissection and anaesthetic infiltration. Avoid medial scars (eg, a 4-o'clock to 7-o'clock position).
- Comprehensive tissue removal: The 360° dissection ensures a thorough removal of enlarged glandular tissue, following its physiological disposition. An attempt has been made to remove the entire tissue in one piece.
- Minimally invasive: This method minimises the invasive nature of the procedure, resulting in less scarring and a lower risk of complications, such as hematomas.
- No drainage tube: The technique eliminates the need for postoperative drainage tubes, which reduces the risk of additional incisions and infection.
- Combined approach: This technique is frequently used in conjunction with the MDC-Sculpt Lipo method, a fat removal procedure, to remove excess fat and sculpt the chest for a defined, masculine appearance.
Case Study: Bilateral Nipple Enlargement as a Secondary Effect of Anabolic Drugs
Professional bodybuilders, especially those taking drugs like anabolic steroids, usually experience true gynecomastia with nipple enlargement, meaning they have more glandular tissue than fatty tissue with elongated nipples [5].
In such situations, they typically don't require liposuction but gynecomastia and nipple reduction surgery only. In most cases, a small mastectomy is done, leaving just a little glandular tissue under the skin. This helps the nipple-areolar complex line up nicely with the shape of the chest muscles [1].
Nipple Reduction Surgery outline
- Comprehensive evaluation: Discussions of aesthetic goals, assessment of chest wall anatomy and symmetry, treatment options and surgery outline
- Minimally invasive: Twilight sedation with procedure typically taking between about 1 and 1.5 hours.
- Preservation of sensation: Preservation of natural nipple sensation where possible
- Tailored excision plan:
- Wedge Excision: For patients who want to reduce size while maintaining natural projection, Dr Puah carefully removes a precise wedge of tissue from the nipple base
- Direct Excision: Reduces the outer edge of the nipple for a smaller diameter while preserving sensation.
- Circumferential Reduction: Used to decrease width and projection when needed; often combines both techniques above for best results.
- Scarless Technique: Healed strategic incisions will be nearly invisible.
- Minimal Downtime: Patients go home the same day, with little discomfort and simple aftercare.
- Goal: Achieve symmetrical results that enhance natural anatomy.
For pseudogynecomastia
Surgical plan: Pseudogynecomastia surgery using Dr Puah's proprietary liposuction method called Modern Liposuction With MDC-Sculpt®️ Lipo Technique.
MDC-Sculpt®️ Lipo Technique at a glance
- Comprehensive surgical approach: Targets different fat layers, addresses skin elasticity, and considers the uniqueness of the anatomy and natural chest contours
- Simultaneous fat removal and skin tightening: Stimulate collagen production during fat extraction, resulting in firmer skin in the chest area without making it look flat and unnatural.
- Scarless result: Strategic micro-incisions will be made in the body's natural creases
- Customised sculpting: Customised cannulas are used to sculpt the body according to gender-specific and body shape contours.
- Minimally invasive: The procedure is performed under twilight sedation (not general anaesthesia) and involves small incisions, making it less traumatic for the patient.
- Permanent fat removal: During the procedure, fat tissue is gently but permanently removed.
