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Signs of a botched gynecomastia surgery: Here's what to look out for
Updated on 9 July 2026
Key takeaway
- Botched gynecomastia surgeries are increasingly common due to high demand, often performed by inexperienced practitioners.
- Red flags include irregular dents, inverted nipples, thick scarring, and asymmetry, with incomplete tissue removal being a major issue.
- Revision surgeries are more complex and should be carried out by experienced doctors, possibly involving liposuction or glandular excision.
- Candidates must be at least 6 months post-surgery, physically healthy, emotionally ready, and committed to aftercare.
Gynecomastia, the enlargement or overdevelopment of breast tissue in men and boys, is increasingly common [1], and so is male breast reduction surgery.
When performed correctly, the procedure permanently removes excess glandular tissue and fat from the chest, improving contour and restoring confidence.
However, with the surge in demand, inexperienced practitioners have entered the field, and botched gynecomastia surgery cases are rising as a result.
Dr Ivan Puah, an MOH-accredited liposuction doctor in Singapore with over 20 years of performing gynecomastia surgery and male chest sculpting experience, explains what can go wrong and how to identify the warning signs.
Complications After A Botched Gynecomastia Surgery
- Irregular dents or depressions in the chest [5]
- Rippling or unevenness of the skin [5]
- Inverted nipples [5]
- Excessive or thick scarring [5]
- Skin contour irregularities [5]
- Crater deformity (A sunken area under the nipple-areola complex caused by over-removal of tissue) [4]
Beyond the physical, the psychological toll of a botched gynecomastia surgery can be severe, including heightened anxiety, embarrassment, and a significant decline in self-confidence [2].
Why does botched gynecomastia surgery happen?
According to studies, fewer than 5% of patients who have had male breast reduction surgery require revision (corrective) surgery.
"However, my observation over the years has been that the percentage of patients requiring revision surgery is higher than official statistics suggest, likely due to inexperienced and untrained doctors using an inappropriate surgical approach," says Dr Ivan Puah.
Incomplete Tissue Removal
The most common cause of poor gynecomastia outcomes is incomplete surgery [6].
This includes:
- Removing fat tissue but leaving glandular tissue untouched (Common in mixed gynecomastia)
- Incomplete removal of glandular tissue (In true gynecomastia)
- Incomplete removal of both fat and glandular tissues
Wrong Treatment Method
Using non-surgical fat reduction treatments, such as fat freezing (cryolipolysis), for gynecomastia can potentially result in the development of Paradoxical Adipose Hyperplasia (PAH), a rare but serious condition in which treated fat cells enlarge and harden, rather than shrink [7].
Poor Doctor–Patient Communication
Inadequate pre-op consultation may result in misaligned expectations and unsuitable surgical plans.
During the consultation, share with the doctor:
- Onset and duration of your medical condition
- Presence of pain or discomfort
- Current and past medications
- Diet, lifestyle, and activity history
- Relevant surgeries, injuries, or health concerns
- Impact on daily activities and life
Lack of Surgical Skill and Aesthetic Judgment
Gynecomastia surgery is not simply tissue removal. The placement of incisions, surgical technique, and the doctor's aesthetic sensibility and experience will determine the final result [8].
Not considering Patients With Different Body Types
A study looked at treating gynecomastia by comparing different body types, such as those who are overweight, underweight, athletic, etc to understand their unique expectations and needs.
The findings showed that treatment should be tailored to each patient's body type and expectations. Most cases didn't need large incisions, which helped minimise scarring [9].
Not considering the patient’s unique skin quality and glandular tissue characteristics
Dr Puah, who has more than 2 decades of experience treating gynecomastia surgery in men of all walks of life and diverse ethnicities internationally and in Singapore, has published research on the surgical treatment of gynecomastia (male breast enlargement) in Asian men.
Drawing on over 550 cases treated between 2018 and 2023, he concluded that gynecomastia treatment in Asian men cannot simply follow Western protocols [9].
It requires culturally and physiologically adapted surgical planning to achieve safe, aesthetically effective outcomes.
"When treating Asian patients, we have to take into account Asian-specific considerations, largely because Asian skin types are more prone to scarring and hyperpigmentation. Differences in skin quality and glandular tissue between Asian and Caucasian patients require tailored incision placement and treatment planning."When Is Gynecomastia Revision Surgery Necessary?
Gynecomastia revision surgery (corrective surgery) is recommended when a patient experiences unsatisfactory results following their initial procedure [10].
Common reasons for revision surgery include:
- Insufficient glandular tissue removal
- Fat removed but glandular tissue left behind
- Crater deformity from over-removal of tissue beneath the nipple-areola
- Visible asymmetry or contour irregularities
Due to the complexity involved, including fibrotic scar tissue, adhesions, and indentations, revision surgery is more challenging and time-consuming than the original procedure [11].
It requires a doctor with specific experience in corrective gynecomastia cases.
What Does Gynecomastia Revision Surgery Involve?
Depending on what the patient presents with, revision surgery may include:
- Glandular tissue removal: If tissue was left behind
- Liposuction: To address residual fat
- Chest sculpting: To improve contour and symmetry
- Fat grafting: To correct crater deformities or indentations
Each case requires meticulous, individualised planning.
Gynecomastia Surgery & Revision Surgery in Singapore
At Amaris B. Clinic, gynecomastia surgery is performed at an accredited Day Surgery centre.
Dr Ivan Puah works alongside a team trained surgical personnel and an experienced anaesthesiologist to ensure patient safety at every stage.
Dr Puah's approach is built on:
- Thorough pre-operative consultation: To align on realistic outcomes and tailor the surgical plan
- Technical precision: With deep expertise in both liposuction and glandular tissue excision
- Aesthetic sensibility: Focused not just on tissue removal, but on creating a natural, contoured chest result
- Comprehensive aftercare: Including structured post-procedure support and monitoring
If you are unhappy with a previous surgery, or have concerns about enlarged male breast tissue, schedule a consultation with Dr Ivan Puah.
FAQ on botched gynecomastia surgery
How common is botched gynecomastia surgery?
Official statistics suggest fewer than 5% of male breast reduction patients require revision surgery.
However, according to Dr Ivan Puah, the real number may be higher due to underreporting and the growing number of inexperienced practitioners.
Can gynecomastia come back after surgery?
In most cases, gynecomastia surgery offers a permanent solution.
However, if the underlying cause (such as hormonal imbalance or medication) is not addressed, or if the initial surgery was incomplete, tissue may return.
What is a crater deformity after gynecomastia surgery?
A crater deformity occurs when too much tissue is removed beneath the nipple-areola complex, leaving a sunken or hollowed appearance.
It is a known complication of over-aggressive gynecomastia surgery and can be corrected with fat grafting.
How do I choose the right doctor for gynecomastia surgery in Singapore?
To choose the right doctor for gynecomastia surgery in Singapore, look for an MOH-accredited doctor with extensive, documented experience specifically in gynecomastia surgery, not just general liposuction.
Prioritise clinics that perform procedures in accredited Day Surgery facilities with on-site anaesthesiologists and emphasise open pre-operative communication.
Is fat freezing safe for gynecomastia?
Fat freezing is not recommended for gynecomastia. Enlarged breast tissue does not respond to fat freezing.
It can cause Paradoxical Adipose Hyperplasia (PAH), a condition in which fat cells enlarge rather than decrease, thereby worsening the condition. In addition, if fat cells adjacent to the breast glands are indeed thinned out by freezing, it may paradoxically make the enlarged glands look more prominent than before.
Reference
[1] Koch T, Bräuner EV, Busch AS, Hickey M, Juul A. Marked Increase in Incident Gynecomastia: A 20-Year National Registry Study, 1998 to 2017. J Clin Endocrinol Metab. 2020 Oct 1;105(10):dgaa440. doi: 10.1210/clinem/dgaa440. PMID: 32754750.
[2] Arvind A, Khan MA, Srinivasan K, Roberts J. Gynaecomastia correction: A review of our experience. Indian J Plast Surg. 2014 Jan;47(1):56-60. doi: 10.4103/0970-0358.129624. PMID: 24987205; PMCID: PMC4075218.
[3] Zavlin D, Jubbal KT, Friedman JD, Echo A. Complications and Outcomes After Gynecomastia Surgery: Analysis of 204 Pediatric and 1583 Adult Cases from a National Multi-center Database. Aesthetic Plast Surg. 2017 Aug;41(4):761-767. doi: 10.1007/s00266-017-0833-z. Epub 2017 Mar 24. PMID: 28341949.
[4] Ali, S. S., Ahmed, I., Khurram, M. F., Rehman, N., & Abhishek, R. (2025). Gynecomastia Surgery: Liposuction Alone versus Liposuction with Endoscope-Assisted Glandular Excision—A Comparative Study. Indian Journal of Plastic Surgery, 58(04), 269-275.
[5] Karthik Ramasamy, Sanjib Tripathee, Anitha Murugesh, Joyce Jesudass, Rakesh Sinha, Abisshek Raj Alagarasan, A Single-Center Experience With Gynecomastia Treatment Using Liposuction, Complete Gland Removal, and Nipple Areola Complex Lifting Plaster Technique: A Review of 448 Patients, Aesthetic Surgery Journal Open Forum, Volume 5, 2023, ojac095, https://doi.org/10.1093/asjof/ojac095
[6] Caridi, Robert C. MD. Total Gynecomastia Removal with Layered Closure: A Study of 567 Cases. Plastic and Reconstructive Surgery - Global Open 10(4):p e4256, April 2022. | DOI: 10.1097/GOX.0000000000004256
[7] Nathaniel Stroumza, Nelly Gauthier, Patricia Senet, Philippe Moguelet, Raphael Nail Barthelemy, Michael Atlan, Paradoxical Adipose Hypertrophy (PAH) After Cryolipolysis, Aesthetic Surgery Journal, Volume 38, Issue 4, April 2018, Pages 411–417, https://doi.org/10.1093/asj/sjx159
[8] Arvind A, Khan MA, Srinivasan K, Roberts J. Gynaecomastia correction: A review of our experience. Indian J Plast Surg. 2014 Jan;47(1):56-60. doi: 10.4103/0970-0358.129624. PMID: 24987205; PMCID: PMC4075218.
[9] 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.
[10] Innocenti, A., Melita, D., & Dreassi, E. (2022). Incidence of complications for different approaches in gynecomastia correction: a systematic review of the literature. Aesthetic Plastic Surgery, 46(3), 1025-1041.
[11] Xia, Z. N., Kang, Y. B., Yang, Y. Y., Guan, A., Ma, X. D., Zhang, Y. W., ... & Zhu, L. (2024). Comprehensive aesthetic corrections of gynecomastia using the reproducible safe and minimally invasive surgical strategy. Asian Journal of Surgery, 47(1), 222-228.
