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Male Breast Surgery (Gynaecomastia Surgery)

Gynaecomastia surgery, commonly referred to as male breast reduction, addresses the enlargement of male breast tissue caused by glandular growth.

The MELT Procedure (Microdebrider Excision and Liposuction Technique) is a minimally invasive surgical technique that combines specialised surgical tools and techniques to remove tissue, ensuring minimal scarring, and a natural, contoured chest. This approach is devised for men seeking an effective, minimally invasive solution.

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Dr Terence Goh

MBBS

MMed

MRCS

FAMS

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Male Breast Surgery (Gynaecomastia Surgery)

My Philosophy

“Patients suffering from gynaecomastia have pain and discomfort, but more importantly, there is also an embarrassment, and they do not want to draw unnecessary attention to the chest. Hence, a minimal scar approach is important to reduce this stigmata and also to reduce numbness of the nipples after surgery. Our approach with the MELT technique allows us to contour the chest and remove the breast gland via a small incision. “

Symptoms of Gynaecomastia

  • Abnormal Swelling of Breast Tissue

    Enlargement of breast tissue in males may affect one or both sides and lead to an asymmetrical chest appearance.

  • Firm or Rubbery Lump

    A distinct lump or area of firm, rubbery tissue is often noticeable beneath the nipple and can vary in size and texture.

  • Tenderness or Pain

    The affected area may feel tender to the touch, and discomfort or pain is common, particularly during the early stages.

  • Changes in Breast Shape

    The condition can cause visible changes to the chest shape, such as increased prominence or an uneven contour.

Causes of Gynaecomastia

Gynaecomastia is caused by a variety of factors that can manifest as physical discomfort or noticeable changes in chest appearance.

  • Hormonal Imbalances

    Excessive oestrogen or insufficient testosterone can lead to the development of glandular breast tissue, causing tenderness, swelling, and enlargement.

  • Medications

    Certain drugs, such as anti-androgens, anabolic steroids, and antidepressants, may stimulate the growth of glandular breast tissue.

  • Chronic Conditions

    Disorders like obesity, liver or kidney disease, and thyroid dysfunction may influence hormone levels, contributing to breast tissue enlargement.

  • Substance Use

    Alcohol, marijuana, and anabolic steroids can disrupt hormonal balance, resulting in breast tissue development.

  • Idiopathic Causes

    In some cases, no specific underlying condition is identified, yet glandular breast tissue grows, causing sensitivity and enlargement.

Psychological Effects of Gynaecomastia

Gynaecomastia often impacts mental health and self-esteem, as the condition goes beyond physical discomfort to affect emotional well-being.

Low Self-Esteem

Visible breast tissue can make men feel self-conscious about their appearance, leading to reduced confidence in social or personal situations.

Emotional Distress

The misconceptions or lack of understanding surrounding the condition may cause anxiety or depression, particularly if it limits clothing options or physical activities.

Social Withdrawal

Many men avoid situations like swimming, gym workouts, or public changing rooms to conceal their chest, which can affect their social interactions and fitness routines. Surgery can alleviate these concerns, fostering improved confidence and emotional relief.

Diagnosis of Gynaecomastia

Medical History

The surgeon reviews the patient’s symptoms, lifestyle, and history of medication or substance use to identify possible contributing factors. This step helps determine whether the gynaecomastia is linked to hormonal imbalances, medical conditions, or external causes.

Physical Examination

The surgeon assesses the distribution of glandular tissue and fat in the chest, along with skin elasticity and potential sagging. This examination helps differentiate between true gynaecomastia, pseudogynaecomastia, and hybrid cases.

Diagnostic Tests

Diagnostic tests help determine the cause of gynaecomastia. Blood tests evaluate hormone levels, including oestrogen and testosterone, to identify imbalances or conditions such as endocrine disorders or medication effects. Imaging, such as ultrasound or mammography, confirms whether the enlargement is due to fat, glandular tissue, or both, and rules out other conditions like male breast cancer.

Ideal Candidates for Gynaecomastia Surgery

Gynaecomastia surgery is suitable for men experiencing physical or aesthetic challenges due to an enlarged chest.

Group 1824

Men with Prominent Breast Glands

Those with visible glandular tissue benefit from targeted removal, restoring a flatter chest appearance.

Group 1822-2

Men with Sagging Skin

Individuals with loose skin after significant weight loss can achieve improved contour and firmness through surgery.

Group 1823

Men with Asymmetrical Breasts

Correcting uneven breast development enhances physical symmetry and appearance.

Group 1822

Men with Protruding or Enlarged Areolae

Surgery addresses areolar prominence, contributing to a more masculine chest.

Group 1822-1

Men Committed to Long-Term Results

Combining surgery with a healthy lifestyle ensures enduring improvements in chest contour.

Types of Gynaecomastia

The condition can vary depending on the type of tissue involved. Differentiating these types helps determine the appropriate treatment.

Gynaecomastia-predominantly glandular

True gynaecomastia involves the enlargement of glandular breast tissue, which cannot be resolved through weight loss or liposuction. Surgical removal with precise cutting instruments is the only effective treatment. We prefer the MELT technique for its smaller scars and reduced risk of complications.

Gynaecomastia-predominantly fat

This form of gynaecomastia is caused by excess fat rather than glandular tissue. Unlike true gynaecomastia, it can often be addressed through weight loss. Liposuction is also an effective treatment option.

Gynaecomastia-hybrid

A combination of fatty and glandular tissue, hybrid gynaecomastia is the most common presentation. Treatment combines liposuction for fat removal and surgical excision for glandular tissue.

Gynaecomastia Classification

The condition is categorised based on the extent of breast tissue enlargement and skin redundancy. (Simon Classification)

gynecomastia-grade1

Small enlargement, with tissue concentrated around the areola, without skin excess.

gynecomastia-gradellb

Grade IIa: Moderate enlargement extending beyond the areola, with indistinct edges from the chest, without skin excess.

Grade IIb: Moderate enlargement with some skin excess.

 

gynecomastia-gradelll

Significant enlargement, with significant skin excess, resembling female breasts.

What are the surgery options?

Excision of Fibrous Gland via an Incision Around The Nipple

This technique involves removing the fibrous glandular tissue through an incision around the nipple, performed under local anaesthesia. The incision is placed along the border of the nipple to minimise scar visibility. However, this approach typically results in a larger scar and increased numbness compared to minimally invasive methods such as the MELT procedure.

Excision via Small Stealth Incision Around The Nipple (MELT Procedure)

The MELT procedure is suited for mild to moderate cases with minimal skin excess. This surgery is performed under general anaesthesia and uses a smaller, less visible incision, resulting in reduced numbness and scarring. It is ideal for patients seeking a more refined aesthetic outcome with minimal incision size.

Liposuction

Liposuction is an effective option for treating pseudogynaecomastia, which involves excess fat rather than true glandular breast tissue.

A consultation with a qualified plastic surgeon is necessary to determine the best surgical approach tailored to individual needs.

The M.E.L.T. Procedure

M icrodebride
E xcision
L iposuction
T echnique

The MELT Procedure is a minimally invasive surgical method pioneered by Dr. Terence Goh during his tenure at Singapore General Hospital (SGH). This technique combines liposuction for chest contouring with the use of a microdebrider for effective removal of glandular tissue through a 5-8mm incision, concealed within the areolar skin.

Small scars: The 5-8mm incision provides access for tissue removal while ensuring the resulting scars are barely noticeable and heal discreetly.

Reduced Numbness: Patients report a low incidence of around the nipple due to the smaller and less invasive incisions.

Key Advantages of the MELT Procedure

Accurate Tissue Removal

By using the microdebrider, surgeons can achieve sharp and controlled excision of fibrous breast tissue, allowing for accurate removal while preserving the surrounding areas.

Symmetry and Contour

The technique allows better visualisation during surgery, allowing assessment of both sides of the chest, and enabling the surgeon to make adjustments as needed to achieve a balanced and naturally contoured chest.

Proven Results

The MELT Procedure has consistently delivered positive outcomes for more than a decade, with its effectiveness supported by scientific publications and long-term clinical data.

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Image Azataca CTA Gynaecomastia M

Preparing for the Procedure

Consultation and Assessment

A comprehensive evaluation, including medical history, physical examination, and hormone testing, determines the treatment plan.

Pre-Surgical Instructions

Avoid blood-thinning medications and supplements, which can increase bleeding risks during and after surgery. Stop smoking at least two weeks prior to improve circulation and promote better wound healing. Follow fasting instructions, typically avoiding food and drink for at least 6 hours before surgery, to minimise complications during anaesthesia.

Step-by-Step MELT Procedure

1. Preparation

The chest area is cleaned and prepared under sterile conditions to minimise the risk of infection. Targeted tissue is identified and marked to ensure accurate excision during the procedure.

2. Anaesthesia

General anaesthesia is administered, ensuring the patient is completely asleep and free from pain throughout the surgery, providing a safe and comfortable experience.

3. Tissue Removal

A specialised numbing solution containing adrenaline is injected into the targeted area to reduce bleeding, create a clearer surgical plane, and facilitate precise tissue separation. The microdebrider is used to accurately shave and suction glandular breast tissue through a small incision, while liposuction can be used to address excess fat in the chest area.

4. Closure

After tissue removal, the incision is stitched meticulously and a special adhesive glue is applied on the skin.

Post-Surgical Care and Recovery

Post-surgical care focuses on promoting healing, preventing complications, and ensuring the best possible results.

Drainless Surgery

Since our initial description of the technique, we have evolved the technique to be drainless. However, it is mandatory to wear a vest with surgical foam for 48 hours after the surgery. This is worn continuously and not removed for the first 2 days. Adhering to strict post-surgery protocol enables recovery with a low risk of bleeding and rapid recovery.

Compression Vest

After the first 48 hours, the compression vest is worn for another six weeks to help maintain the chest shape, reduce swelling, and support the healing tissues. During this period, the vest can be removed during a short period of time.

Pain Management

Mild discomfort or soreness is expected and this can be managed with the oral painkillers prescribed.

Follow-Up

The patient is reviewed at Day 2 to remove the foam dressing. Subsequent visits are at 1 week to change dressings and at 3 weeks to evaluate the healing of the incision. Final results are evaluated 3-6 months after surgery.

Recovery Timeline

The surgery is performed as a day surgery. Patients can resume light activities, such as walking, within 1 to 2 days and return to sedentary work in 3 to 5 days, depending on the extent of the procedure and job type. Light exercises not involving the chest can begin after 2 weeks. Strenuous activities, including heavy lifting or chest exercises, should be avoided for 4 to 6 weeks. Following these timelines promotes a smooth recovery and optimal results.

Potential Risks and Complications

While the MELT procedure is generally safe, potential risks may include bleeding or scarring, but are minimised with specialised surgical techniques and appropriate wound management. Asymmetry or residual tissue can arise, though these risks are reduced through real-time monitoring and adjustments during surgery. Fluid build-up (seroma) or swelling is a possible complication, which is effectively managed with the use of compression garments.

Male Breast Surgery (Gynaecomastia Surgery)

Insurance and Medisave Options

Patients with confirmed glandular breast tissue and symptoms of pain or discomfort may be eligible for insurance or Medisave coverage for gynaecomastia treatment.

During the consultation, the surgeon will assess and classify the severity of gynaecomastia. An ultrasound scan is recommended to confirm the presence of glandular tissue. If surgery is performed, the removed tissue will be sent for histological analysis.

Frequently Asked Questions (FAQ)

How soon after surgery can I see results?

Results are visible immediately after surgery as the excess tissue is removed, but swelling may temporarily mask the final outcome. Most patients notice significant improvement within a few weeks, with the full results becoming apparent after six months as healing progresses.

Can gynaecomastia return after surgery?

Gynaecomastia typically does not return if the underlying cause, such as hormonal imbalances or certain medications, is addressed. However, significant weight gain, hormonal changes, or the use of certain substances may lead to recurrence in some cases.

Will the procedure correct asymmetry?

Yes, the MELT procedure is designed to address asymmetry by carefully removing excess tissue and sculpting the chest for a more balanced appearance.

What happens if I gain weight after surgery?

Gaining weight after surgery may result in fat accumulation in the chest area, which can alter the surgical results and partially reverse the improvements. Adopting a stable, healthy lifestyle that includes balanced nutrition and regular exercise helps maintain the contoured chest achieved through the procedure.

Does the MELT procedure address loose skin?

The MELT procedure can address mild to moderate skin laxity by improving chest contour and promoting skin retraction over time. However, significant loose skin may require additional procedures, such as skin excision, to achieve optimal results.

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Dr Terence Goh

Choosing to combine the intricate skills of microsurgery with aesthetic surgery, Dr Goh specialises in gynaecomastia, surgery of the Asian face, particularly Asian eyelid surgery and rhinoplasty.

Blending the precision of microsurgery with the artistry of aesthetic surgery, Dr Goh has a special interest in gynaecomastia, facial procedures, including ptosis and eyelid surgery, as well as rhinoplasty.

He also offers a full range of body contouring procedures such as mummy makeovers, breast augmentation, liposuction, and body sculpting—designed to help patients feel more confident and comfortable in their own skin.

Beyond aesthetics, Dr Goh remains active in reconstructive microsurgery, with expertise in breast reconstruction, head and neck reconstruction, and lower limb salvage—restoring both form and function where it’s needed most.

  • Bachelor of Medicine, Bachelor of Surgery, National University of Singapore
  • Master of Medicine, National University of Singapore
  • Member of the Royal College of Surgeons
  • Fellow of the Academy of Medicine, Singapore (Plastic Surgery)
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