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Gynaecomastia
Gynaecomastia surgery addresses excess breast tissue or fat in the male chest (man boobs, moobs).
It may be appropriate where this causes persistent discomfort or distress despite non-surgical measures. The focus is on determining whether surgery is appropriate and what underlying factors should be addressed.
My Approach
My approach focuses on evaluating potential physiological, pharmacological, and pathological causes first. Most commonly, gynaecomastia is a benign process that, once stabilised for at least a year, can be addressed surgically. When it persists beyond 12 months, surgical excision is the treatment of choice, as spontaneous resolution becomes unlikely beyond this point. In rare cases, there may be underlying issues such as liver or thyroid problems which may need further investigation and treatment separately.
The goal of gynaecomastia treatment is to achieve a natural, masculine chest contour through precise surgical technique and attention to proportion. Surgery is performed as a day procedure under general anaesthesia, with the aim of a smooth, tapered transition from chest to abdomen without visible irregularities or feminising features.
In Singapore, gynaecomastia surgery is usually eligible for claims under Medisave and insurance. The amount depends on clinical assessment and prevailing Ministry of Health (MOH) guidelines.
Planning & Technique
Most cases are treated with a combination of liposuction and direct gland excision through a small incision at the lower border of the areola. This allows removal of both fatty and glandular tissue while minimising scarring. The combination of liposuction and subcutaneous gland excision is well-supported as the preferred surgical approach for grade I-II gynaecomastia, with studies reporting low complication rates, low recurrence, and excellent patient satisfaction
A key part of the operation is to release the inframammary fold (IMF) - a subtle but important step often overlooked. Without this release, the chest skin may remain tethered, producing a feminising crease beneath the nipple. Releasing the IMF allows the skin to redrape naturally over the chest for a more defined, masculine result.
Another important nuance is to leave a thin layer of tissue beneath the nipple to prevent a “dinner-plate” or sunken-in appearance that can occur when too much tissue is removed. This preserves the natural chest contour while ensuring smooth transitions. Leaving a thin retroareolar layer of tissue is a recognised technical principle as complete retroareolar excision risks crater deformity and compromised blood supply to the nipple-areolar complex.
For selected patients with mild skin excess, energy-assisted liposuction devices can aid contraction. More significant laxity can be addressed with direct skin tightening or staged correction.
Recovery & Expectations
Most patients can return to light activities within a few days and to desk work in under a week. A compression garment is worn for about 4 to 6 weeks to control swelling and aid contouring.
Mild bruising and firmness are common initially and settle gradually as tissues remodel. In some cases, there may be temporary altered sensation of the nipple, which usually recovers on its own within 6 to 8 weeks. Exercise can resume progressively after about 4 weeks, depending on recovery.
Scars are typically well-concealed along the edge of the areola. Results are stable once swelling subsides, and recurrence is rare when hormonal causes are excluded.
Post-operative care extends beyond routine reviews - it is an integral part of Dr Ng’s surgical philosophy. Through Doctor Stitch, an aftercare service founded to ensure seamless continuity and comfort, every patient is followed up personally by Dr Ng for attentive, discreet, and consistent care throughout the recovery journey.
Frequently Asked Questions
1. Is gynaecomastia surgery painful?
Most patients experience only mild to moderate discomfort after surgery, which is well controlled with standard analgesia. Pain tends to decrease significantly after the first 48 to 72 hours.
2. How long is recovery after gynaecomastia surgery?
Most patients return to light activities within a few days. Swelling and bruising are noticeable in the first week and improve over the next 2 to 3 weeks. Strenuous activity and upper-body exercises typically resume after about 4 to 6 weeks, guided by individual healing.
3. Will there be visible scarring after surgery?
Scars are placed strategically, usually around the areola or in discrete chest creases to minimise visibility. Over time, scars generally soften and fade, though the exact appearance varies by individual healing patterns.
4. Can gynaecomastia surgery be performed with liposuction alone?
Yes, in appropriate cases, liposuction alone can address excess fat. However, when there is significant glandular tissue or skin laxity, direct excision combined with liposuction provides a more balanced and stable contour. This is determined during consultation and pre-operative planning.
5. Is gynaecomastia surgery only cosmetic?
While there is a strong cosmetic component, many patients seek gynaecomastia surgery for functional or psychological concerns such as chest discomfort, self-consciousness in social situations or athletic wear, or interference with physical activity. Gynaecomastia is also recognised to have significant psychological impact, including depression, anxiety, body dissatisfaction, and reduced self-esteem, with surgical treatment demonstrably improving psychological health, self-confidence, and quality of life outcomes.
6. Will mammary tissue come back after surgery?
Glandular tissue removed surgically does not typically return. However, weight gain, hormonal changes or certain medications can contribute to recurrence of soft tissue fullness, so maintaining a stable weight and healthy lifestyle is important. Long-term follow-up data at nearly 14 years confirms that recurrence after surgical excision of true glandular gynaecomastia is uncommon, reported at 12.5% compared to 62.5% in lipomatous cases, underscoring the importance of distinguishing glandular from fatty excess before surgery.
Related Reading
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Liposuction - learn about the approach and thinking behind the use of liposuction as an adjunct in body contouring procedures
References
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Baumann K. Gynecomastia - Conservative and Surgical Management. Breast Care (Basel). 2018 Dec;13(6):419-424. doi: 10.1159/000494276. Epub 2018 Nov 14. PMID: 30800036; PMCID: PMC6381901.
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Schröder L, Rudlowski C, Walgenbach-Brünagel G, Leutner C, Kuhn W, Walgenbach KJ. Surgical Strategies in the Treatment of Gynecomastia Grade I-II: The Combination of Liposuction and Subcutaneous Mastectomy Provides Excellent Patient Outcome and Satisfaction. Breast Care (Basel). 2015 Jul;10(3):184-8. doi: 10.1159/000381152. Epub 2015 Apr 7. PMID: 26557823; PMCID: PMC4569250.
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Ali SS, Ahmed I, Khurram MF, Rehman N, Abhishek R. Gynecomastia Surgery: Liposuction Alone versus Liposuction with Endoscope-Assisted Glandular Excision-A Comparative Study. Indian J Plast Surg. 2025 Jan 23;58(4):269-275. doi: 10.1055/s-0045-1802327. PMID: 40894818; PMCID: PMC12396856.
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Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. Gland Surg. 2018 Aug;7(Suppl 1):S70-S76. doi: 10.21037/gs.2018.03.09. PMID: 30175067; PMCID: PMC6107601.
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Fricke A, Lehner GM, Stark GB, Penna V. Long-Term Follow-up of Recurrence and Patient Satisfaction After Surgical Treatment of Gynecomastia. Aesthetic Plast Surg. 2017 Jun;41(3):491-498. doi: 10.1007/s00266-017-0827-x. Epub 2017 Mar 9. PMID: 28280898.
