The Ultimate Guide to Gynaecomastia in Singapore (2021)

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Dr Terence Goh

June 18th, 2020· 5 min read

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Having male breasts can be a distressing experience. This condition is actually more common than we think.

Up to 50% of males may have gynaecomastia at some point of their lives and it can create a lot of embarrassment and affect self-esteem.

In fact, a lot of patients have told me that they are even shy to admit that they have the condition and find it embarrassing to ask for help.

It’s difficult to know what to do to get rid of it. Do you exercise? Does exercise get rid of the problem? Do you need liposuction or do you need surgery?

Gynaecomastia is a condition that has multiple causes which may be difficult to identify.

As a plastic surgeon, I would like to share with you more about this distressing but easily treatable condition:

  • What is Gynaecomastia?
  • What causes Gynaecomastia?
  • How can we classify Gynaecomastia and what is pseudo-gynaecomastia?
  • What symptoms will you have?
  • What treatments are there and what can you do to prepare for the surgery?

Plastic surgeons also treat other conditions such as abdominoplasty, which you can read about here.

What is gynaecomastia?

Gynecomastia is a condition affecting males where they have increased breast tissue, leading to enlarged breasts.

This is caused by hormone imbalances where the affected person has more oestrogen than testosterone.

This imbalance can occur naturally such as when a boy undergoes puberty, or through other conditions such as obesity [1].

What causes gynaecomastia?

Causes of gynaecomastia, 4 causes

Gynaecomastia can affect males of all ages, but it commonly affects 2 main age groups - young teenagers and older males [2].

As this condition is caused by a hormonal imbalance, diseases that lead to an overproduction of oestrogen or underproduction of testosterone can also cause gynaecomastia.

These conditions include but are not limited to:

  • Liver diseases
  • Testicular tumours
  • Pituitary disorders

Gynaecomastia can also be caused by medications that lead to a hormonal imbalance. In these cases, the condition is only temporary and your chest will return to normal size over time if you stop the medication.

Chronic conditions such as being overweight or being obese also lead to increased production of oestrogen, hence cutting down on weight may lead to reduced breast size.

However, if there is a prominent breast disc, weight loss alone will unlikely result in a satisfactory outcome.

In most cases, there is no underlying cause, and there is an enlarged breast disc which does not reduce in size. It is in these cases that surgical reduction is the most effective treatment.

Read more: I also have a guide on mummy-makeovers here on Human.

How is gynaecomastia classified?

Example of grade 2 gynaecomastia

Typical appearance of a Grade 2 gynaecomastia without excess skin. This is the most common presentation of gynaecomastia in my practice.
(Reference: Journal of Plastic, Reconstructive & Aesthetic Surgery (2020) 73, 303–312. Review of the microdebrider excision and liposuction technique (MELT) for the treatment of gynecomastia. N.Sim, T Goh, et al)

There are many different classifications for gynaecomastia which have evolved since the original Simon classification [3].

The one that I find that’s the easiest for patients to understand divides gynaecomastia into 4 grades or stages:

  • Grade 1: (Mild) Within the confines of the nipple areolar complex without excess skin
  • Grade 2: (Moderate) Exceeds the confines of the nipple areolar complex without excess skin
  • Grade 3: (Moderate) Exceeds the confines of the nipple areolar complex with excess skin
  • Grade 4: (Severe) Excesss skin with feminisation of the chest

Gynaecomastia, or male breast, can be predominantly fatty adipose tissue, glandular, or a mix of both glandular and fatty tissues.

If your condition is caused by too much fat, it is termed pseudo-Gynaecomastia.

This does not mean that your condition is ‘fake’, it just means that its causes are not glandular in origin.

True gynaecomastia is due to glandular tissue enlargement, where the breast gland increases in size.

types of gynaecomastia

What are the symptoms associated with Gynaecomastia?

Whilst gynaecomastia is a physical enlargement of the breast and is an aesthetic issue, it can often be associated with tenderness, hypersensitivity, and pain.

Some males feel embarrassed by the enlarged breasts, leading to situations where men avoid tight-fitting shirts [4].

It is also worth noting that 1% of all breast cancers occur in males so if you have symptoms of sudden enlargement or growth around the nipple area it would be advisable to have it checked early.

Do diet and exercise work?

Unfortunately, the answer is no if you have true gynaecomastia. Whilst pseudo-gynaecomastia due to excess fat may improve with diet, exercise and weight loss, the fibrous breast disc does not disappear. The only reliable method to remove it is with surgery.

Who should seek gynecomastia surgery?

Prominent breast discs pinched between 2 fingers

Prominent breast discs can be pinched between 2 fingers. You will be able to feel a discrete fibrous disc that is different in consistency with the rest of the fat.

I recommend the following patients to go for surgery:

  1. Patients with prominent breast tissue who are bothered by it
  2. Patients who have prominent breast discs. You can check by pinching your chest, if you are able to pinch something firm and fibrous under the nipple, that is probably the fibrous breast disc
  3. Patients with large areolar or protruding nipples
  4. Patients with sagging breast with skin excess after weight loss
  5. Patients who are bothered by the appearance of their chest, despite trying diet and exercise regimes

What kind of doctor do I see for treatment?

No treatment is normally required for most cases of gynaecomastia.

Some patients experience temporary gynaecomastia during puberty and most of this (90%) disappears within 3 years or before the age of 21.

There are cases of gynaecomastia which may be a sign of underlying conditions or a side effect of medication.

In such cases, patients should seek treatment of the underlying condition with an endocrinologist first as this may lead to improvement of the gynaecomastia.

For patients with persistent glandular enlargement, I would recommend removal of the gland and chest contouring procedures to be done.

what surgical treatments are there for gynaecomastia?

What surgical treatments are there for Gynaecomastia?

Gynaecomastia surgery or reduction mammaplasty in males is an effective way to reduce breast size, repair nipple areolar abnormalities, and recreate chest contours.

You will have to either remove breast gland tissues (Gynaecomastia), fat tissues (Pseudo Gynaecomastia) or both.

Whilst the fat and gland require different treatment modalities, liposuction of the adipose (fat) tissue and removal of the gland can be performed simultaneously in the same surgery.

The treatment for pseudo-gynaecomastia is liposuction, where fat is removed from your breasts.

First, I would plan for the incisions to be made within the areolar which creates a “scarless” entry.

Then, a cannula is inserted to loosen the fat under the skin.

Finally, the fat is sucked out until the desired level is reached. In most cases up to Grade 2 or even 3, the excess skin should usually retract without need for any skin reduction.

The glandular breast tissue cannot be removed simply by liposuction alone as it is hard and fibrous.

Treatment of fibrous gynaecomastia with liposuction alone often leads to unsatisfactory results.

I have numerous patients coming to see me after undergoing prior liposuction.

They have a flat chest but a prominent nipple and fibrous breast disc. The glandular breast tissue would require some form of sharp excision to reliably remove it.

The options for removal of the breast disc are:

  • Mini Excision: A minimally invasive cut (0.5-1cm) is made and the tissue is pulled out piece-meal and removed. This is feasible only for small breast mounds.

  • Open Excision: A larger incision (2-3cm) is made around the areolar and the tissue is excised under direct vision. This method can be done under local anaesthesia but it leaves a scar and can also sometimes lead to a sunken nipple.

  • Excision with sharp cutting tools: A microdebrider is an instrument that can simultaneously cut tougher tissues and suck them out immediately once cut.

    The tool is shaped like a tube with blades at the end that can be controlled to cut smaller or larger pieces, depending on what is required.

    This can be inserted via a small 0.5 cm incision.

    This is my personal preferred method and something that I have devised and been using since 2010.

If you have excess skin (Grade 3 or 4 gynaecomastia), you may also need to undergo:

  • **Skin reduction: Excess skin may be left alone during the first surgery so that it recedes during recovery.

    If this occurs to a satisfactory degree, then no further treatment is needed. However, if excess skin still remains, it can be removed in a second procedure.

    You can also choose to excise the excess skin in the first procedure. In severe cases of excess skin, you will need to prepare for extra scars in the shape of an incision around the nipple or an inverted T.**

Mini excision or open excision can be performed under local anaesthesia.

Excision with microdebrider, liposuction or procedures with skin reduction will have to be performed under general anaesthesia, so you will be unaware of what is going on.

The procedure is usually completed in 1-1.5 hours. For almost all of my cases, the patients are discharged on the same day and they are able to manage the pain with oral painkillers.

Introducing the MELT technique

MELT stands for ‘Microdebrider Excision and Liposuction Technique’.

This is a hybrid technique created by our team back in 2010, which uses the microdebrider to remove the hard fibrous breast disc and liposuction to sculpt the chest.

Combining my experience and extensive research, I have written articles on the use of Microdebriders and why I think this is the Gold standard for removal of prominent breast glands.

This technique leads to fewer complications and better result satisfaction when handling the fibrous breast discs [5].

MELT improves on older techniques, such as open excision or liposuction which either lead to more scars or fail to remove the fibrous tissues.

This novel technique combines the efficacy of sharp excision with the ability to contour the chest through a small incision.

MELT, step-by-step walkthrough of the technique

MELT uses a combination of liposuction while using a tool called a microdebrider to remove the fibrous breast disc through a small 0.5 cm incision hidden within the areolar.

As explained above, the microdebrider is a tool used to make small, controlled cuts with suction at the end to remove the tissues cut. It is somewhat like a razor blade that you use for shaving, except it has a suction attached to it. Learn more about MELT here.

Here’s what happens when you undergo the operation, in 4 easy steps [6].

  1. First, I make a 5mm incision within your nipple and use a skin protector to protect your skin
  2. I then use liposuction to suck out the fat tissue I planned to remove during pre-operative planning
  3. After removing the fat, I use the microdebrider to cut the fibrous part of the tissue away layer by layer
  4. Finally, I smooth out tissue edges and close the incision with absorbable sutures

Microdebrirder and MELT

An example of how step 1 is carried out with a microdebrider The microdebrider is a cannula with a sharp cutting rotary blade. It can be introduced under the breast through a small 5mm incision which can be easily hidden at the areolar-skin interface. The incision will be made in the hole in the plastic sheath. The inner circle is the fibrous breast disc and the outer circle marks the border of the fatty tissue.
(Reference: Journal of Plastic, Reconstructive & Aesthetic Surgery (2020) 73, 303–312. Review of the microdebrider excision and liposuction technique (MELT) for the treatment of gynecomastia. N.Sim, T Goh, et al)

So which procedure is suitable for me?

Liposuction Only

Excision only


Hospitalisation required ?

Day Surgery, No need for overnight stay

Day Surgery, No need for overnight stay

Day Surgery, No need for overnight stay


General Anaesthesia

Local Anaesthesia

General Anaesthesia


4 weeks no chest exercise

6 weeks no chest exercise

6 weeks no chest exercise









Risk of residual breast disc




Risk of bleeding




The most suitable procedure for you depends on the condition and severity of your gynaecomastia and your expectations regarding scars.

In my opinion, the MELT technique is superior and especially useful for thin or muscular individuals with little fat and a prominent breast disc or individuals who are concerned about scarring.

Direct excision can be performed under local anaesthesia and hence the costs will be lower due to the cost savings from the facility charges. However, there may be a slightly higher risk with scarring.

What happens during the consultation with the plastic surgeon?

Bring all your available medical reports, previous x-rays and mammograms so that I have a baseline for your medical health.

I will take your medical history, asking you when you noticed your breasts had enlarged and whether you are taking any particular medications. I might order an ultrasound to investigate if there are suspicions of a growth. You might need to take a blood test to ensure that your gynaecomastia is not caused by hormonal imbalances that can be resolved through other means.

Once all this data is collected and we are sure you have gynaecomastia or pseudogynecomastia, we will plan your treatment plan together.

How much does gynaecomastia removal surgery cost?

Gynaecomastia surgeries can cost anywhere from $6000-$13,000.

Treatment, broken down into parts


Gynaecomastia Surgery

  • Surgeon Fee
  • Anaesthesia fee
  • Facility fee
  • Medications and Consumables

Range : $6500-$13,000

  • $3000-$7000
  • $1000-$1500
  • $2000-$4000
  • Around $500

Gynecomastia is not usually covered by Medisave. However, there are some insurance policies that may cover gynaecomastia surgery, especially when it is symptomatic. Please check with your insurer or my clinic staff to find out more.

What do I need to prepare for surgery?

As there is a risk of bleeding involved post-surgery, you will have to stop medications that increase bleeding risk. Smoking also affects your healing rate, so you will have to stop smoking for at least 2 weeks beforehand.

What risks are there when undergoing surgical treatment?

Gynecomastia surgery is a safe procedure when performed by trained doctors. Patients are discharged on the same day and follow-up can be done in the outpatient clinic. Having said that, though uncommon, there are some potential complications:

  1. Swelling. Your chest will be swollen for the first 1-2 weeks and it would take time for the swelling to subside. You will be given strict instructions on how to manage the swelling.

    You would need to wear a vest for 6-12 weeks to help to sculpt the chest, reduce the swelling and help manage the discomfort.

  2. Bleeding Risk. There is a small risk of bleeding and bruising. This is reduced by ensuring that you stop smoking and are not on any blood thinners or food that causes a similar effect.

  3. Numbness. You may feel numb over the chest for a short period, though numbness for a long period of time is unusual.

  4. Asymmetry or residual breast disc. There may be too much or too little tissue excised, and there may be an asymmetry between your two chest’s breasts.

    Over-excision will lead to a sunken chest which although removes all the breast tissue, creates an unnatural appearance.

    On the other hand, residual breast disc left behind may mean that the chest profile is not flat.

    This can be reduced by experience and also use of the MELT technique which allows the operator to compare both sides before closing the incisions.

    Extensive pre-planning and computer imagery reduce these risks. Following post-surgical aftercare will also lead to faster recovery.

  5. Scars. There can be unsightly scars at the point of incision. This is why I think it’s important to place the incision within the areolar complex and also to limit the incision where possible. Prominent scars on a flat chest will still draw unnecessary attention.

Well healed scar

Close-up of a well-healed incision placed around the 6 o’clock position of the areolar.
(Reference: Journal of Plastic, Reconstructive & Aesthetic Surgery (2020) 73, 303–312. Review of the microdebrider excision and liposuction technique (MELT) for the treatment of gynecomastia. N.Sim, T Goh, et al)

What is recovery like?

Most of my patients are discharged on the same day and the pain is controlled with oral painkillers. They would need to wear a pressure garment for 2-3 months.

This is to reduce swelling and fluid collection. You will be able to exercise after six weeks (a month and a half). You should be able to see the final results after 6 months.

What if I’m unhappy with my results?

While it’s understandable if you’re not satisfied with the immediate outcome of the surgery, I generally recommend you wait for a few months, after you heal, to let the skin and breast settle in shape.

The final result may differ slightly from the immediate outcome and settle into the expected form.

If you are still unhappy after that, you should return to the same plastic surgeon and discuss the results and next steps.


You have learned that there are many causes of gynaecomastia, including hormonal imbalances from underlying medical conditions.

However, sometimes enlarged breasts may be stubborn and may remain enlarged despite other types of treatment. In these cases, surgery is a viable option.

Through extensive planning together, I will be able to explain the best course of treatment for you. Thank you for reading, and I hope this information arms you with the confidence to manage and overcome this issue!

Enjoyed this piece? Read another article on Human about avoiding painful threadlifts in Singapore.

Dr Terence Goh is a Plastic Surgeon at AZATACA Plastic Surgery and is currently the president of the Singapore Association of Plastic Surgeons, and the vice-chairman to the Chapter of Plastic Surgeons, Academy of Medicine, Singapore. His area of practice is in reconstructive microsurgery, which includes breast reconstruction, complex head and neck reconstruction, lower limb salvage, and lymphatic reconstructive surgery.

Read more of Dr Terence Goh's QnA here.

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This article was written by Dr Terence Goh and published on Wednesday, 25 January 2017. Human medically reviewed the article on Wednesday, 25 January 2017. The last update was made on Friday, 18 September 2020.

Disclaimer: Opinions belong to the author and not to the platform.

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