Is Scarless Gynecomastia Surgery Medically Possible?

What type of scar will I get after my gynecomastia surgery?

Can you make the gynecomastia surgery scars less obvious?

Dr Ivan Puah has more than 17 years of liposuction and body sculpting surgical experience, including performing gynecomastia surgery and corrective gynecomastia surgery in male patients from all walks of life and diverse age groups and ethnicities in Singapore and the Asia Pacific. He often hears the above questions from patients during their gynecomastia surgery consultation.

But lately, a question often asked, which begets a scratch on the head, was…

I read about scarless gynecomastia surgery online; can you do that? Can you guarantee that there will not be any scars after the surgery?

Scarless gynecomastia surgery

We see many Google ads and articles from medical providers marketing gynecomastia surgery as "Scarless Gynecomastia Surgery." Scarless, by definition, is no scar, so how does one do surgery without scarring from the incision site… because a cut is a cut, right?

After all, the objective of gynecomastia surgery is to excise the enlarged male breast tissue, and depending on the patient's gynecomastia grading score, the tissue can be quite a size!

Anatomy of the Gynecomastia Tissue

If you are unaware of the anatomy of the gynecomastia gland, here is a picture of two glandular tissues removed by Dr Puah.

Normal breast glandular tissue size is less than 2 cm in width. The glandular tissue in a gynecomastia patient is usually larger than 2cm [1]. The enlarged male breast tissue consists of a head, body and tail. The head's shape is semicircular and located towards the body's centre, while the tail tapers off the body to the side and towards the pecs and humerus area. The size of the glandular tissue and the amount of chest fat in a gynecomastia patient make every surgery unique [2].

FACT: IT IS IMPOSSIBLE to remove enlarged male breasts with radiofrequency heat or non-invasive treatments. Glandular tissues CANNOT BE MELTED, FROZEN, BLASTED, ETC. It has been proven that the only intervention is to SURGICALLY REMOVE the tissue from the body.

So, how can removing these sizable tissues not cause any scarring? First, let's understand how a typical gynecomastia surgery is done.

What happens during a traditional gynecomastia surgery?

Traditional gynecomastia surgery involves creating large linear incisions under the breast to allow the removal of enlarged breast tissue and chest fat. This tends to result in prominent, linear, thick scar formation under the breast post-surgery.

After the procedure, the surgeon must also make a second incision for fluid drainage. Drainage tubes actually increase the risk of wound infection and additional surgical scars.

Since incision is necessary, how is scarless gynecomastia surgery possible? Is it possible to not have scars after surgery?

Did you know that a whopping "100 million patients develop scars in the developed world alone each year due to 55 million elective operations?" [3]

The study on the relationship between immunological mechanisms of scarring and their psychological impact on patients stated that "some studies have found that dark-skinned individuals are more likely to form scars than light-skinned individuals and that there also is a dependency on genetic factors.”

Those who notice that their scars tend to be bumpy and reddish or even much bigger than the initial size of the wound are likely to have hypertrophic scars or keloids. Keloids occur when you have too much collagen in your skin. But keloids are not uncommon; it is estimated that there are 11 million people with keloid scars [4].

What you read online about "scarless gynecomastia surgery" is that the incisions will eventually fade to an unnoticeable colour, depending on how your scar heals, such as the size, location of the incision, genetics and post-surgery wound care.

What the gyno doctor can do on his part to minimise scarring are how and where the incision was made and closed

How and where the incision was made

A skilled and experienced doctor is capable of making clean incisions on your chest. When the doctor's hands are steady, and the cut is clean, chances of the wound healing well are highly likely.

How the incision was closed

The wounds will be closed using special suturing technique with a thin, smooth-surface suture to minimise wound tension. They will, therefore, cause less scarring.

While the gynecomastia doctor will do their utmost best to ensure the scarring will be minimal – after all, each surgery is a doctor's work of art – please be realistic in your expectations. Doctors use surgical tools, not magic wands, to help you gain body confidence. Nobody can give their word that your scar will fade away completely.

However, what can be assured is that your gynecomastia surgery scarring can be much less visible with Gynecomastia Surgery that combines Dr Ivan Puah's proprietary gyno technique called 360° GTD® technique.

Dr Puah's Gynecomastia Surgery with 360° GTD® technique - Step by Step

Sedation and Anaesthesia

The gynecomastia surgery is carried out in our MOH-approved Day Surgery Center, equipped with modern surgical equipment. Our panel of anaesthesiologists will provide twilight sedation for the patient. This will allow the patient to undergo the surgery in the safest and most comfortable environment.

Permanent removal of enlarged male breast tissue Liposculpture for chest fat reduction and chest contouring

Through tiny incisions around the areola, tissue dissection is carried out carefully following the physiological disposition of the glandular tissues. This way, the scarring will be significantly minimised and well-camouflaged when it heals, and the haematoma risks are also reduced considerably.

Gynecomastia Surgery with 360° GTD® technique does not require postoperative drainage to avoid leaving unsightly scars and, more importantly, reduces the risk of postoperative infection.

For those with excess chest fat, Dr Puah will not only the fat tissues but also sculpt and enhance the chest contours with another of his patented body sculpting approaches known as the MDC-Sculpt®️ Lipo Technique. It is a multi-dimensional contouring approach tailored to each patient's fat anatomy, fat distribution, muscular curvature and skin laxity.

Close incisions with fine stitching

A typical gynecomastia surgery will take between 1.5 to 2.5 hours. After the surgery ends, the incisions will be carefully closed with stitches. Sterile dressings and a compression garment will then be applied. Our experienced post-surgery team will care for you while you rest at the recovery bay.

Discharge on same day with a flatter chest

Once you've come to and are ready to head home, you will be discharged on the same day with a post-op care kit and a detailed aftercare advisory. Our medical team will be in close contact with you, supporting you at every step in your recovery process. You can WhatsApp us at +65 9152 4140 should you have any questions or doubts regarding your post-surgery symptoms.

Benefits of Dr Ivan Puah's Unique Gynecomastia Surgery with 360 degrees GTD® technique

The benefits of Dr Ivan Puah's award-winning proprietary gynecomastia surgical technique include:

• Involves minimal and strategically placed incisions less than 4mm
• Permanent and thorough glandular tissue reduction
• Reduces the risks of haematoma
• Tightens skin for a smoother chest contour
• Methodological sculpting techniques for a natural-looking chest
• No post-surgery drainage tube thus reducing scarring and risk of infection
• Minimal disruption to daily activity and work
• High and consistent patient satisfaction

Do gyno surgery scars go away? How do you prevent scar formation after gyno surgery?

Your gyno scars will lighten and improve with time.

Swelling

Tissue swelling after any surgeries is expected. It will take several weeks for the swelling to subside.

General lifestyle choices

When you are healing, adopt HEALTH - Hydrate, Eat well, Avoid drinking, Leave smoking, Think positive and Have plenty of rest. As a matter of fact, adopt HEALTH even when you are not sick to be in the pink of health, inside and out.

Sun protection

Sun exposure can darken the scar colour. Avoid outdoor activities that require you to remove your shirt for at least 6 months. If unavoidable, apply sunscreen SPF 30+ and double up with scar reduction gel/cream.

Silicone sheets/gel, vitamins & natural treatments

Silicone has been used for decades to hasten scar discolouration. It can come in gel form and self-adhesive sheets. Vitamin E and Aloe can also help with scar healing. Green tea extract and onion are key ingredients in anti-scar cream as they contain antioxidants that help with collagen development.

Anti-scar massage after gynecomastia surgery with Manual Lymphatic Drainage Massage (MLD)

At Amaris B. Clinic, we recommend Manual Lymphatic Drainage Massage (MLD) carried out by our MLD therapist to all our post-gynecomastia surgery patients.This encourages blood flow to avoid the build-up of lymph fluid in the body, stimulates the healing process, improves skin texture and minimises scar formation.

We would like to reiterate that sometimes, despite the best effort and care from the patient and doctor, a scar may inevitably form. The scar's final result greatly depends on the person's genetic disposition to scarring. If their body produces more collagen and is prone to keloid scarring, then there is nothing much one can do to avoid this. Each patient experiences wound healing uniquely, and preventing the formation of scarring is virtually impossible.

High post-gynecomastia surgery patient satisfaction rate at Amaris B. Clinic

One of the best ways to prevent significant scarring is to choose an MOH-accredited, highly qualified doctor experienced in performing gynecomastia surgery like Dr Ivan Puah.

Dr Puah is the sole doctor in Singapore to receive dedicated surgical training in gynecomastia surgery. His proficiency in gynecomastia surgery is marked by a notable success rate and high level of patient satisfaction, according to ‘Amaris B. Patient Post-Surgery Survey Report’ collected over the decades.

His proprietary surgical approaches are tailored to meet the unique needs of each gynecomastia patient.

Gynecomastia Surgery Singapore (Male Breast Reduction)

Wanting to explore the option of gynecomastia surgery is a highly personal decision, and we understand the importance of such a decision. We invite you to arrange a consultation with Dr Ivan Puah at Amaris B. Clinic.

During the consultation, you will be able to engage in an informative and candid discussion to better comprehend how we can assist you in addressing your specific body concerns. Our commitment to your well-being extends beyond surgical procedures. We prioritise your comfort, safety and, of course, results throughout your journey with us.

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Reference

[1] Braunstein, G. D., & Anawalt, B. D. (2020). Clinical features, diagnosis, and evaluation of gynecomastia in adults. Up to date.

[2] Kanakis, G. A., Nordkap, L., Bang, A. K., Calogero, A. E., Bártfai, G., Corona, G., ... & Jørgensen, N. (2019). EAA clinical practice guidelines—gynecomastia evaluation and management. Andrology, 7(6), 778-793.

[3] Sund B. (2000) New Developments in Wound Care. PJB Publications, London, pp. 1–255.

[4] Shen W, Xu W, Chen H. Immunological mechanisms of scarring and their psychological impact on patients. Am J Clin Exp Immunol. 2021 Oct 15;10(3):65-70. PMID: 34824895; PMCID: PMC8610804.