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Gynecomastia 101


Gynecomastia, also known as man boobs or enlarged male breasts, is a medical condition that affects over 60% of males. The effects of gynecomastia go beyond physical discomfort and feminine appearance.

Gynecomastia glands removed

Depression & Anxiety

Men with gynecomastia who do not seek surgical intervention have the psychological burden of depression and anxiety [1].

Body Dissatisfaction

Body image perception is disturbed in adolescents with gynecomastia mostly if not entirely with regard to one body part, the breasts [2].

Low self-confidence

Gynecomastia as a condition causing a feminised outlook may have a negative impact on self esteem and body image [3].

Teenage/Adolescent Gynecomastia

The child may appear more withdrawn, has erratic mood swings and prefers to be alone, opting out of social activities.


Gynecomastia and pseudogynecomastia may look the same physically, but they are very
two different conditions.




Involves only the glandular tissue or glandular tissue with a combination of excess fat tissues on the chest.


Due to only fat deposits without the involvement of glandular tissues.

Comparison cause



Hormonal imbalance leading to the development of enlarged breast tissues. It can affect one or both breasts.


It is simply due to the extra fat accumulation in the chest area, usually caused by weight and/or fat gain.

Comparison difference

Tell the difference


The affected area can feel sore, tender, and/or painful, accompanied with swelling and sometimes, nipple discharge. You will feel a firm, rubbery lump in one or both breasts.


Breasts feel soft and evenly enlarged. There is no pain or soreness upon touch. Your areolas are not enlarged, and your nipples are not sore or discharging.

Comparison treatment

Recommended treatments


Gynecomastia surgery involving 360° Glandular Tissue Dissection (360°GTD®) and liposuction.


Modern Liposuction with the MDC-Sculpt®️ Lipo technique can effectively address pseudogynecomastia by removing excess chest fat.


Adapted from the McKinney and Simon, Hoffman and Kohn scales [4]

Gynecomastia grade 1

Grade I

Small breast enlargement with a localised button of tissue concentrated around the areola.

Gynecomastia grade 1

Grade II

Moderate breast enlargement exceeds areola boundaries, with edges indistinct from the chest.

Gynecomastia grade 3

Grade III

Moderate breast enlargement exceeds areola boundaries with edges distinct from the chest with skin redundancy present.

Gynecomastia grade 4

Grade IV

Marked breast enlargement with skin redundancy and feminisation of the breast.


When the person wears a form-fitting T-shirt, the breasts look like female breasts. Other gynecomastia symptoms may also include swelling, pain, soreness and, in some extreme cases, nipple discharge. Suspect that you may be suffering from gynecomastia? Do a self-check!

Self-check pinch test

Pinch Test

When you pinch a typical breast tissue, it usually feels firm. The tissue may also resist the pinch a little. Also, when you pinch the areola from end to end with your thumb and forefinger, the tissue rim should be no bigger than 1/2cm in diameter. When one has gynecomastia, there would be no resistance and no tissue rim.

Self-check visual inspection

Visual Inspection

Normal male chest has a thin layer of tissue with small flat areolas. You are certainly suffering from gynecomastia if your chest looks more feminine, and has puffy nipples with abnormally wide areolas.

Self-check touch assessment

Touch Assessment

If you can feel a firm mound of mass around the areola area that feels painful or tender to touch, you are likely suffering from gynecomastia.


Dr Ivan Puah

Dr Ivan Puah has close to two decades of liposuction and body contouring experience. He is certified to perform laserlipolysis (laser liposuction), Vaser liposuction and Hi-Definition liposuction having completed his liposuction and body sculpting training in the United States, Italy and Argentina. His passion for body contouring further drives Dr Ivan Puah to pursue further surgical trainings in gynecomastia surgery in the United States.

He developed two proprietary surgical techniques: 360° GTD® for gynecomastia surgery and MDC-Sculpt®️ Lipo Technique for liposuction.

Dr Puah is known to patients as a pragmatic gentleman - managing realistic expectations, not overpromising and under-delivering results.

He is also the Chairman of Lipo Peer Review Committee in Singapore.

Dr Ivan Puah


Proprietary 360° Glandular Tissue Dissection (360°GTD®️) and MDC-Sculpt® lipo techniques

  • 360° Glandular Tissue Removal

  • Meticulous chest sculpting

  • Strategically placed incisions

  • Minimal scarring & incidence of haematoma

  • Lesser downtime, bruising & discomfort

  • Faster recovery with minimal disruption to your daily activities

Lipo techniques

The Artistry Of Enhancing You

MOH-approved Operating Theatre & Experienced Panel Of Anaesthesiologists

Performing surgeries at an MOH-accredited facility with our panel of anaesthesiologists and offering twilight sedation (no GA) allow the best care and safety for you during and after surgery.

Consistent High Patient Satisfaction & Positive Patient Experience

Integrity, ethical, and commitment, that's our pledge to you.

Personalised Care

No one body is the same. You are unique, and so are your concerns, needs and desires. This is why every treatment plan varies for each different patient. We listen to what you want before designing your personalised plan to meet your goals.

Amaris B. Clinic is passionate about celebrating the exquisite, natural human form.  

Our aim is to deliver results that are not just beautiful but authentically you.

Dr Ivan Puah embraces the belief that there's no cookie-cutter, one-size-fits-all approach when it comes to aesthetics and body sculpting.

Instead, he takes the time to carefully assess your unique features and tailors a treatment plan to meet your aesthetic goals.


At what age is gynecomastia permanent?

Once developed, gynecomastia that persists after ONE year of unsuccessful medical treatment will require surgery.

Male with long nipples - Normal or a medical issue?

Men complaining of long nipples are a minority and are bothered mainly by their appearance. Nipple reduction surgery is a solution to treat this condition.

Can gynecomastia come back after surgery?

Reoccurrence of gynecomastia is uncommon.  A 2017 study in the Aesthetic Plastic Surgery Journal revealed that only 12.5% experienced recurrence over 10 years later. In summary, nearly 90% of patients won't see a return of gynecomastia post-surgery.

Statistics indicate that up to 70% of men may experience gynecomastia to varying degrees in their lifetime, impacting mental health. However, the psychological effects are alleviated post-surgery.

A study in the World Journal of Plastic Surgery revealed that most patients remain content with the results over time, emphasising the rarity of gynecomastia recurrence.

How much does a gynecomastia surgery cost in Singapore?

The costs of gynecomastia surgery in Singapore will vary between practices, and the following factors will determine the price.

Generally, the doctor's fees for performing gynecomastia surgery are based on experience and the case's complexity. Other charges include the type of anaesthesia used, surgical facility costs, medical tests such as blood tests, post-surgery garments, pre and post-medication, specimen (biopsy), etc.

While costs are one of the variables you need to consider, the doctor's experience and the variety of gynecomastia cases he has treated and your comfort level with him are just as necessary as the final cost of the surgery.

Will I be awake during gyno surgery?

With Dr Ivan Puah's surgical approach, there is no need for the patient to undergo general anaesthesia. The patient will be under twilight sedation during the procedure. Our anesthesiologist will ensure that you are safe and comfortable throughout the process.

Is gynecomastia surgery covered by insurance or MediSave?

Before understanding if your gynecomastia surgery is covered financially by insurance or MediSave, we encourage you to visit Dr Ivan Puah for a consultation.

A complete history, physical examination, and appropriate diagnostic tests are needed to determine the underlying cause of your condition. Following that, he will be able to advise you on whether surgery is medically necessary or not. If proven it is, you may be able to tap into your insurance or MediSave.

What if gynecomastia is left untreated?

Aside from discomfort and pain, gynecomastia, if left untreated, will not improve or resolve by itself. It may affect the individual physically, emotionally, mentally and psychologically.

Can I get rid of gynecomastia with cream, pills or non-invasive treatment such as fat freezing?

No. Gynecomastia is a male breast disorder involving abnormal proliferation of breast tissues. It cannot be treated non-surgically with fat freezing or low-energy laser, nor can it be resolved by exercising or dieting. Cream and spray will not work either.


[1] Nuzzi, Laura C. B.A.; Cerrato, Felecia E. M.P.H.; Erikson, Cameron R. B.S.; Webb, Michelle L. B.A.; Rosen, Heather M.D., M.P.H.; Walsh, Erika M. M.D.; DiVasta, Amy D. M.D., M.M.Sc.; Greene, Arin K. M.D., M.M.Sc.; Labow, Brian I. M.D.. Psychosocial Impact of Adolescent Gynecomastia: A Prospective Case-Control Study. Plastic and Reconstructive Surgery 131(4):p 890-896, April 2013. | DOI: 10.1097/PRS.0b013e3182818ea8

[2] Esenboğa, S., Akgül, S., Kanbur, N., Tüzün, Z., & Derman, O. (2015). The effect of gynecomastia on body image perception and gender roles in adolescents. Turk J Pediatr, 57(1), 60-67.

[3] El Noamani, S., Thabet, A. M., Enab, A. A., Shaeer, O., & El-Sadat, A. (2010). High grade gynecomastia: surgical correction and potential impact on erectile function. The Journal of Sexual Medicine, 7(6), 2273-2279.

[4] Simon, B.E., Hoffman, S., Kahn, S. Classification and surgical correction of gynecomastia. Plast.Reconstr. Surg. 51:48-52, 1973.


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