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Cryolipolysis (Fat Freezing)
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Gynecomastia Surgery

Gynecomastia (pronounced guy-neh-co-mastia) is Greek for women's breasts. The term was first coined by Galen, a second century AD physician. Gynecomastia is used to describe excess glandular and/or fatty breast tissues in man. It refers to enlargement of the glandular component of the breast, in reality for most patients, there is an excess of both fat and glandular tissue.
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Gynecomastia comes in a variety of degrees ranging from very mild to significant enlargement, sometimes accompanied by sagging of the skin.
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Disclaimer: Individual results may vary. Image above is for illustrative purposes only.

WHAT IS GYNECOMASTIA?

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

The most used classification is based on the tissue components involved in gynecomastia:

True Gynecomastia
When only glandular tissue is the cause of male breast enlargement
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Pseudogynecomastia
When it is due to only fat deposits without the involvement of glandular tissues
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Mixed Gynecomastia
When both fat and glandular tissues are the cause of enlarged male breasts enlargement

GYNECOMASTIA SYMPTOMS

An indication that a person may be suffering from gynecomastia is when the affected area appears to resemble that of a woman’s breasts. Enlarged breast tissues, soreness and tenderness are also present and for some people, swelling, pain and nipple discharge may also be experienced.
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A self-check method that can be easily applied is to feel, gently with the fingertips, for the presence of a soft, rubbery lump in the breast areas. Such presence may indicate the possibility of gynecomastia.
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Gynecomastia can occur in one or both breasts. The size of the lumps may also differ from the other. Aside from tenderness and soreness, a person suffering from this condition may also experience pain and discomfort.

As such, an appointment with a qualified doctor is highly advised to ascertain the cause of the issue and if it is indeed gynecomastia.

what causes gynecomastia?

Genetics and hormonal imbalance are some causes of gynecomastia. Additionally, the use of anabolic steroids may also lead to the development of the condition as with the side effects of certain medications and conditions. Age and huge weight loss are also causal factors.

Puberty brings about changes to the body. Among boys, these changes can sometimes lead to gynecomastia.

GYNECOMASTIA GRADES/CATEGORIES

Gynecomastia (True and Mixed) is universally classified under Gynecomastia Scale under Grade I, II, III and IV, according to the severity of breast tissue enlargement.
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Gynecomastia Grade I
The initial stage is characterised by minor breast enlargement with a small localised tissue around the areola or surrounding nipple area; without the development of excess skin. At this stage, it is generally less noticeable with clothing but can be evident when undressed.
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Gynecomastia Grade II
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.
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Gynecomastia Grade III
Grade III will see a moderate to significant enlargement in the breast tissue. This physical change lends an appearance that resembles a woman’s breasts and is often noticeable.
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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.

Who gets gynecomastia?

Gynecomastia is caused by hormone imbalance. The majority of patients developed the condition during puberty that doesn't go away even well into adulthood. This is known as natural or "idiopathic" gynecomastia.
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Another common cause is the consumption of hormones or prohormones supplements. This usually happens among young men and commonly for bodybuilding reasons. These supplements over time cause a hormonal disturbance which can lead up to the development of glandular type gynecomastia. Uncommon medical issues and medications make up the last and minute category of gynecomastia patients.
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Although the causes of gynecomastia may vary, the treatment is the same - "Gynecomastia Surgery."

What does gynecomastia look like?

A normal male chest is not round, and the nipples are small and flat. The outline of the pectoralis muscle is also visible and moves when flex. In gynecomastia, patients and because there is tissue development between the muscle and skin, the chest is more rounded, and the nipples appear puffy.
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Visually, it looks like a person has headlights on his chest when wearing a tight t-shirt. What is seen may only be a small indication of a more significant problem.
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So it is always best to seek qualified advice to better understand and effectively address the issue.

PSEUDOGYNECOMASTIA VS GYNECOMASTIA

Pseudogynecomastia is also a real issue. Unlike gynecomastia, it is caused by the presence of excess fat not involving glandular tissue generation. Men who suffer from pseudogynecomastia will be advised to embark on an exercise and weight loss program and if no change is observed, liposuction will be recommended. Gynecomastia, on the other hand, cannot be treated with diet, exercise or liposuction.

Here’s a guide on the efficacy of the different treatments when it comes to treating gynecomastia and pseudogynecomastia.

Exercise
It has little effect for those suffering from gynecomastia aside from helping to get rid of excess fat. Exercise has no effect on the glandular tissue, which is the concern of gynecomastia patients. For pseudogynecomastia patients, exercise and a healthy diet may help to improve their condition.
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Non-invasive Fat Reduction Treatment
As with exercise, improvements in gynecomastia may only be experienced in the form of fat reduction with no effect on the glandular tissue. In pseudogynecomastia, a patient will experience fat reduction but it depends on the individual’s responsiveness and anatomy to the treatment.
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Liposuction
Liposuction is a commonly sought-after treatment to remove excess fat but in true gynecomastia and mixed gynecomastia, it does not have any effect on the glandular tissue. It is more effective for those suffering from pseudogynecomastia as the main issue is excess fat.
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Glandular Tissue Removal Surgery/Gynecomastia Surgery
This treatment is effective for gynecomastia patients as it not only gets rid of the glandular tissue, it can also reshape the chest’s appearance. Those suffering from pseudogynecomastia need not undergo this treatment as often, a liposuction procedure would suffice.

Gynecomastia is caused by obesity?

Contrary to popular misconception, being overweight is not the only cause of gynecomastia. It may be caused by hereditary and ageing as some men experience bodily changes as they get older.

Is gynecomastia caused by genetics?

Gynecomastia is an endocrine system disorder that causes an enlargement in the size of male breast tissue. Other causes of man boobs may be due to:

• Certain medications
Some antibiotics, heart medicines, heartburn medications, anti-anxiety drugs, antidepressants, and other medications
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• Drugs and Alcohol
Marijuana, heroin, amphetamines, anabolic steroids, and excessive alcohol

• Medical Conditions
Overactive thyroid, kidney disease, etc

Is gynecomastia an early sign of breast cancer?

Breast cancer is not only subjected to women as men can get them, although it's very rare that it happens. Gynecomastia, however, is not a sign of developing breast cancer. Also, excessive breast development and breast cancer are not correlated.

Is gynecomastia caused by male menopause?

According to statistics, male menopause or andropause happens when testosterone production drops in men aged 50 or older. Testosterone fuels changes during puberty and affects a man's mental and physical energy. It also regulates other key evolutionary features. As the levels of testosterone drops, it causes a hormonal imbalance, and these may eventually lead to the development of gynecomastia.

I am overweight. How do I lose the fat and excess breast tissue?

For those who are overweight, it is to assume that they can lose the extra fat that is prevalent in the chest area with dieting and exercise, only to make things worse. The unflattering chest appearance became more noticeable.
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Maintaining a healthy weight and body is always recommended. If being overweight is an issue, do make an effort to lose the extra weight. If you think you're suffering from gynecomastia, then do seek a qualified doctor's advice as soon as possible to safely and effectively address the issue.

Can I exercise or diet gynecomastia away?

Unfortunately, it is not possible to get rid of gynecomastia with exercise because the majority of the time, the problem is excess glandular tissue which no amount of exercise or healthy eating will eradicate. In fact, many men have reported that as they lose weight, the gynecomastia actually looks worse because the fatty tissue around the gland shrinks and the gland subsequently stands out more, making the condition more prominent.

Can only overweight men get male boobs?

The more fat tissues you carry, the higher your chance of developing gynecomastia, so the problem is prevalent among overweight men. However, men who are in great shape do suffer from the condition as well because it is caused primarily by a hormone imbalance.

Can doing more chest exercise reduce the swollen man boobs?

Gynecomastia is caused by hormone imbalance, so while exercising is good, it does not resolve the underlying issue at all.

Can anabolic steroids eliminate gynecomastia?

Anabolic steroids contain a lot of testosterone, which when considering that gynecomastia is caused by a hormone imbalance where one's estrogen level is higher, sound like a solution right? Wrong.
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Apart from other potential health issues, steroid use is actually the primary trigger for gynecomastia. When you're on steroids and then stop taking them, your testosterone levels will fluctuate, causing an increase in your estrogen level. This often leads to fat development in the chest area.
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Don't self-medicate and mess with your hormones, always seek appropriate and qualified doctor’s advice.

Can Gynecomastia be treated?

Yes, the predominant treatment to deal with gynecomastia is surgical - gynecomastia surgery.

Topical creams and massages will rectify gynecomastia?

Despite what's being purported, there is no scientific evidence to prove that topical creams, fat freezing machine, fat reduction machines, or massage techniques can solve the condition permanently. Gynecomastia surgery is the option for surgical correction of gynecomastia.

Can food containing soy beans cause gynecomastia?

Soy contains isoflavones, a class of phytoestrogens which may mildly mimic the hormone estrogen. The effects of soy isoflavones on estrogen levels are complex, but in general, soy is safe to be consumed in moderation. Eggs, milk and other food products that contain hormones are safe for consumption when taken in moderation.

Male breasts can be reduced by using pills and creams?

Currently, there is no scientific evidence that pills or creams marketed can address gynecomastia. Your best option would be surgery.

Can beer give you male boobs?

Hoppy beers like IPA (Indian Pale Ale) contain phytoestrogen, a plant-based estrogen hormone. The common myth is that drinking too much of them will cause estrogen levels to skyrocket. Truth is, the phytoestrogen levels are too low to create any hormone imbalance. But still, consuming beers or any alcohol excessively can be detrimental to your overall health.

Am I a suitable candidate for Gynecomastia?

Gynecomastia surgery is recommended for those suffering from gynecomastia for longer than 12 months, and those whose gynecomastia does not resolve independently or with other means of management. The surgery is suitable for those who have prominent bilateral breasts enlargement or unilateral (one-sided) breasts asymmetry. Males with saggy breasts following massive weight loss and dieting. Males who have protruding and prominent areolas.

WHAT HAPPENS DURING GYNECOMASTIA CONSULTATION AT AMARIS B. CLINIC?

We believe a detailed clinical consultation and physical examination play an integral part not only in diagnosing your condition but also in planning a tailored treatment for you. During consultation, 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:
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• Medical history
• When and how long you've started noticing the signs of abnormal chest enlargement
• Any pain, discomfort accompanying the physical changes?
• Medications that you have taken or 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?

WHAT DOES GYNECOMASTIA SURGERY BY DR IVAN PUAH INVOLVE?

Having undergone dedicated training in gynecomastia surgery in the USA, Dr Ivan Puah further refined his surgical skills and developed a novel surgical technique - 360° Glandular Tissue Dissection (360°GTD®).

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° glandular tissue dissection is then performed carefully following the physiological disposition of the glandular tissues.

VASER Lipo is performed on those with fat tissues enlargement of the breasts. The VASER probe delivers ultrasonic sound wave energy which breaks down the fatty tissues efficiently while leaving the surrounding connective tissues, blood vessels and nerves relatively undisrupted.

Dr Ivan Puah carefully suctions the liquefied fat with a specialised cannula and further contours the chest, leaving the area with a sculpted look. Furthermore, VASER Lipo stimulates collagen production for better skin tightening.

HOW DOES GYNECOMASTIA SURGERY BY DR IVAN PUAH DIFFERS FROM OTHERS?

Each gynecomastia case is unique and the surgical approach that is developed by Dr Ivan Puah takes into careful consideration the degree of the gynecomastia, glandular tissue-to-fat ratio and parenchyma distribution of the patient.

He will propose an individualised approach for the patient after careful assessment of the patient’s clinical condition and understanding of the patient’s concerns with the ultimate aim to effectively achieve male breast reduction by removing fibrous and painful glandular tissues and/or fat tissues to restore a natural looking masculine body shape, with the smallest possible incision.

Is gynecomastia surgery a complicated procedure?

Gynecomastia surgery takes approximately 2 hours. Breast tissue and/or fat tissues are removed during the procedure. Patients are discharged on the same day, and most patients can resume work within 1 to 2 days.

How long does the surgery take?

Gynecomastia surgery may take between 1 to 2 hours.

CHOOSING A GYNECOMASTIA DOCTOR IN SINGAPORE

Making the appropriate choice is pivotal when it comes to addressing an issue like gynecomastia. As much as we want it to be resolved as quickly as possible, it is advisable to not be too hasty in the search for help. There are plenty of horror stories and botched jobs to remind us of this importance.
Here are a few tips to note when deciding on your doctor.
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Experience
An experienced doctor is not only able to identify the underlying issues of a condition but more importantly, is also able to effectively address it safely with satisfying results. Look for a doctor that does the procedure on a regular basis (with proven results) and one who is meticulous and particular about standard and quality.

Before & After Patient Photos
The doctor or clinic should have a set of “before” and “after” photos made available. Most often, these are good indicators of the quality, standard and results you can expect.
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Communication Skills
• It is important that a doctor makes you feel comfortable and is able to answer your concerns and queries.
• The doctor should also be able to explain the reason/s a certain procedure is chosen or preferred over another to address your issue.
• A doctor should be patient when addressing questions and concerns. He should not overwhelm or pressure a patient into agreeing to treatments that they (the patients) do not understand when it comes to the purpose of such treatments.
• A doctor should be able to convey his opinions in a manner that is easily understood and assure his patients particularly in regards to their safety during the procedure.
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Additionally, the clinic staff should also be exemplary of the quality and care standard of the clinic. They ideally, should have decent experience and knowledge in dealing with patients with differing issues and needs. In an essence, your experience from the moment you step into the clinic until you leave should cast a positive imprint and make you feel confident.

Can the GYNECOMASTIA SURGERY only be performed by plastic surgeons?

No. As gynecomastia surgery involves liposuction and breast tissues removal, all doctors who are offering this service, including plastic surgeons alike, have to meet the stringent criteria set by the board and be accredited by the Ministry Of Health Singapore. Dr Ivan Puah is one of the doctors to receive the accreditation.

CAN GYNECOMASTIA SURGERY BE PERFORMED AT THE SAME TIME WITH ANOTHER PROCEDURE?

Yes, full male body contouring is sought after by male patients and they normally request for fat reduction of the abdomen and waists at the same time as their male breasts reduction surgery.

WHO WILL PERFORM THE GYNECOMASTIA SURGERY?

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 VASER Lipo, VASER Hi-Def Lipo and correction body contouring surgeries since 2008. He received dedicated surgical training in gynecomastia surgery under gynecomastia specialist, Dr Miguel Delgado in the USA.

What should I expect after my procedure?

The recovery time varies with every patient and the type of activity the patient intends to resume. The patient can return home after surgery and will require adequate rests in the days after surgery. Most patients resume light activities within 2-3 days. Exercise is usually commenced at about 4-6 weeks.

HOW MUCH DOES A GYNECOMASTIA SURGERY COST?

Costs for gynecomastia surgery will vary between different practices. At Amaris B. Clinic, the costs of surgery is dependable upon the patient’s clinical condition and complexity of the surgery. Dr Ivan Puah tailors the approach for the surgery to your clinical condition, taking into consideration the gland size, fat layers and skin laxity. We also perform gynecomastia revision cases for those who have had gynecomastia done but with less than satisfactory results.

Will my skin sag after gynecomastia surgery?

Most of the patients have degrees of gynecomastia that are not excessively saggy, and so in these instances, the skin elasticity will ensure that the skin snaps appropriately into a more aesthetically pleasing position. Wearing the compression garment will also help to guide the skin back into the desired position.

Do you offer any aftercare treatment?

At Amaris B. Clinic, aftercare plays a significant role not only to assist you with faster recovery but to ensure optimum results. Therefore after the treatment, we offer a bespoke aftercare program designed to help with the healing process.

Is recurrence of gynecomastia common after gynecomastia surgery?

Even in the event of a complete excision, the doctor may still leave behind some glandular tissue. This is due to both structural and aesthetic reasons, particularly to make the chest appear more natural. Although rare, 10% of patients who have had surgery may experience a recurrence of gynecomastia. Aging, hormonal changes, alcohols, the use of opioids, anabolic steroids, certain medication and drugs are usually associated with the onset of gynecomastia.

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 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 and his medical team.

4D CHEST REMODELLING BY 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 and 360°GTD® to remove the glandular tissues, further sculpt and shape the chest and correcting disproportionately shaped nipples.

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