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Dr Ivan Puah's Unique 360°GTD®️ technique to address gynecomastia in bodybuilders
Updated on 2 July 2026
Key Takeaway
- Gynecomastia in bodybuilders is most often caused by anabolic steroid use.
- Steroid abuse disrupts the body's testosterone-to-estrogen balance and causes glandular breast tissue to enlarge.
- As bodybuilders typically carry under 10% body fat, standard gynecomastia surgery approaches aren't ideal.
- Gynecomastia surgery in bodybuilders must remove glandular tissue while preserving chest muscle definition, with attention to low body fat and aesthetic sensibility.
- Dr Ivan Puah, an MOH-accredited liposuction doctor in Singapore, developed the 360°GTD® Technique specifically to address this through a single incision under 4mm, reducing scarring and bleeding risk while sculpting the chest.
Why Bodybuilders Get Gynecomastia
Gynecomastia, the medical term for enlarged male breast glandular tissue, is common among bodybuilders, and the primary driver is anabolic steroid abuse [1].
Steroid abuse is documented as widespread in bodybuilding. It disrupts normal hormone regulation, causing glandular tissue beneath the nipple to swell, amongst other health issues [2].
Left untreated, the condition can be physically painful and, for competitive bodybuilders, undermines the symmetrical, defined chest appearance that judges score on stage.
Why Bodybuilders Need a Different Surgical Approach in Gynecomastia Surgery
Most gynecomastia patients carry more general body fat, giving gynecomastia doctors more tissue to work around.
Bodybuilders are different. This is why addressing gynecomastia in bodybuilders requires a different approach, since they typically carry less than 10% body fat. With so little fat cushioning the area, the margin for error is smaller [3].
Dr Ivan Puah notes that this low-fat, high-muscle profile also raises the stakes around bleeding and healing:
"Special attention is crucial in treating bodybuilders with gynecomastia to prevent bleeding and scarring. Enlarged chest muscles can lead to a higher risk of bleeding, especially with anabolic steroid use and certain unregulated supplements. Besides removing the excess tissue, care must be taken to sculpt the chest to enhance their musculature and help achieve their desired physique."
Not just bodybuilders, patients of different ethnicities may also require a tailored surgical approach. In Dr Ivan Puah's research paper, "Surgical Management of Gynecomastia in Asian Men – Clinical Experience and Considerations for Different Patient Types," he found that surgical techniques often need to be adapted to manage scarring and hyperpigmentation, both of which tend to be more pronounced in Asian skin types.
As Asian and Caucasian patients with gynecomastia differ in skin quality and glandular tissue characteristics, treatment planning must account for these distinctions, particularly when it comes to careful incision placement [4].
What Is the 360°GTD® Technique?
The 360°GTD® Technique is a proprietary surgical method developed by Dr Ivan Puah to treat gynecomastia in muscular, low-body-fat patients, such as bodybuilders.
It works through:
- A single micro-incision: No larger than 4mm, made endoscopically.
- Fluid infiltration: Anaesthetic fluid is introduced through the incision to prepare the treatment area.
-
360-degree tissue excision: The glandular tissue is addressed by following its natural physiological layout.
This approach is designed to:
- reduce the invasiveness of surgery
- produce a more natural, sculpted cosmetic result
When Should Bodybuilders Get Gynecomastia Surgery?
Dr Ivan Puah recommends bodybuilders undergo gynecomastia surgery to remove enlarged glandular tissue before they begin training for an event or competition.
This timing allows the chest to heal properly ahead of intensive training, rather than competing against a recovery timeline once training has started.
FAQ on Gynecomastia in Bodybuilder
Does bodybuilding cause gynecomastia?
Bodybuilding itself doesn't cause gynecomastia. Anabolic steroid use, which is common in some bodybuilding circles, is the typical trigger. Steroids alter hormone balance in ways that cause glandular breast tissue to enlarge.
Can gynecomastia be fixed with diet or exercise alone?
No. Gynecomastia involves glandular tissue growth, not just fat. It does not respond to diet or exercise and generally requires surgical removal.
Is gynecomastia surgery different for bodybuilders than for other patients?
Yes. Bodybuilders typically have less than 10% body fat, so gynecomastia doctors have less tissue margin to work with and must take extra care to avoid bleeding, scarring, and loss of muscle definition – the concerns the 360°GTD® Technique was specifically designed to address.
How big is the incision for the 360°GTD® technique?
The incision is no larger than 4mm. It is made endoscopically to allow infiltration of anaesthetic fluid before the glandular tissue is treated.
When should a bodybuilder get gynecomastia surgery before a competition?
Ideally, start a training cycle for the event so the chest has time to heal fully, usually about 6 months, before intensive training resumes.
Reference
[1] Beniwal, M., Singh, K., Singh, P., Sharma, A., & Beniwal, S. (2023). The burden of anabolic androgenic steroid-induced gynecomastia. Indian Journal of Plastic Surgery, 56(04), 338-343.
[2] Vojvodic, M., Xu, F. Z., Cai, R., Roy, M., & Fielding, J. C. (2019). Anabolic-androgenic steroid use among gynecomastia patients: prevalence and relevance to surgical management. Annals of Plastic Surgery, 83(3), 258-263.
[3] Blau, M., & Hazani, R. (2015). Correction of gynecomastia in body builders and patients with good physique. Plastic and Reconstructive Surgery, 135(2), 425-432.
[4] Puah IBK. Surgical Management of Gynecomastia in Asian Men - Clinical Experience and Considerations for Different Patient Types. World J Plast Surg. 2025;14(3):101-107. doi: 10.61882/wjps.14.3.101. PMID: 41607568; PMCID: PMC12843043.
