Why some men in Singapore get breast reduction surgery

SINGAPORE – In his teen years, Michael (not his real name) started wearing dark hoodies and loose clothing to hide his shape.

The 27-year-old had gynecomastia, a non-cancerous condition where men have enlarged breast glands.

Michael’s chest appeared puffy and swollen and he had a lump around each nipple. He avoided tight or light-coloured clothes, which might make the condition more noticeable.

In 2026, he opted for minimally invasive surgery to remove the enlarged glandular tissue. Since the procedure, he no longer worries about what he wears.

“It’s no exaggeration to say it’s been life-changing for me,” he says.

Gynecomastia, often called “man boobs” or “moobs”, is a common and benign condition that affects at least half of adolescents in Singapore across all ethnicities. It also affects more than 30 per cent of men.

Patients may feel awkward and self-conscious because they do not have the flat chest expected in men.

Ivan Puah, a liposuction doctor accredited by the Ministry of Health, and medical director of private clinic Amaris B. Clinic, has seen hundreds of patients with gynecomastia. They range from teens to middle-aged men.

“For people who are not affected by this, it’s difficult to understand how gynecomastia affects patients,” he says.

“They feel awkward and uncomfortable and lack confidence when they are aware that their breasts are enlarged.”

His patients may resort to taping their nipples, wearing double layers of clothing and choosing only dark and loose clothing to hide their shape.

Some work out, hoping to reduce the size of their breasts. However, this does not fully resolve the issue, since gynecomastia is caused by enlarged glandular tissue rather than extra fat.

Puah says: “Most of our patients are affected psychologically. Men typically feel more normal and feel more masculine when they have a flat and normal-looking chest.”

Influenced by hormones

Savitha Ramachandran, a senior consultant at Sengkang General Hospital (SKH), says gynecomastia presents as a result of hormonal fluctuations.

It is different from pseudogynecomastia, which refers to excess fat deposition in the chest without an increase in glandular tissue.

Gynecomastia can even occur in newborns, due to the influence of maternal oestrogens.

In Singapore, 50 per cent to 60 per cent of all adolescents, across ethnicities, have gynecomastia. This is because during puberty, hormonal fluctuations temporarily increase the ratio of oestrogens to androgens.

Androgens are hormones that influence the display of male characteristics in the body, while oestrogens lead to the display of more female characteristics.

Ramachandran says gynecomastia is reported in 30 per cent to 65 per cent of men. Testosterone production declines with age and body fat increases, resulting in greater conversion of testosterone to oestrogen.

The risk of developing gynecomastia is greater in people who are overweight, especially overweight adolescents.

Chronic liver disease, chronic kidney disease, hyperthyroidism and testicular disorders, including injury, can lead to gynecomastia, adds Ramachandran.

“Gynecomastia may be the first sign of an underlying hormonal imbalance or a condition affecting the body’s overall health,” she says. It is thus important to have it evaluated clinically.

Gynecomastia differs from breast cancer, which is rare in men, she adds.

People with gynecomastia may notice a firm, rubbery lump under the nipple, breast enlargement, tenderness or sensitivity or a puffy appearance around the nipple.

In breast cancer, however, the cancer typically presents as a hard, irregular, often painless lump that may not be centred under the nipple.

Patients with breast cancer may also notice skin changes, nipple retraction or bloody nipple discharge.

Treating gynecomastia

Puah says gynecomastia is graded from level 1, where breast enlargement is small, to level 4, where breast enlargement is marked and exceeds the boundaries of the areola region around the nipple.

Treatment depends on how it affects the patient’s daily life.

Ramachandran, who is with SKH’s Plastic, Reconstructive & Aesthetic Surgery Services, says gynecomastia can spontaneously resolve in many adolescents, once hormone levels stabilise.

The patients she sees for gynecomastia are seeking help to rule out cancer or less benign conditions.

SKH does not record how many surgical operations are carried out annually for gynecomastia.

Ramachandran says not all patients opt for surgery. If the gynecomastia is due to natural hormonal changes that have since stabilised, surgery is not always necessary, she adds.

Where surgery is recommended, options include removing the breast tissue through a small cut (open excision) or liposuction to remove excess fat and tissue.

Another minimally invasive technique is microdebrider excision, where a small, rotating device is used to remove the excess tissue.

Plastic surgeons usually perform surgical operations for gynecomastia.

Puah says patients can return to normal activities within days. They might feel as if they have pulled a muscle in their chest. They should avoid gym activities and strenuous exercise for a few weeks.

He did more than 550 surgical operations for gynecomastia between 2018 and 2023. The Covid-19 pandemic lockdowns led more patients to schedule appointments.

Since then, the annual numbers have dropped, he says, though he has yet to analyse data from 2024.

“What we see in the clinic is the tip of the iceberg. Many people with this condition are still not aware that it can be treated,” he says.

Psychological impact of surgery

Puah says many of his clients do not talk to their families about having gynecomastia, even though they may have been hurt by comments on their appearance.

“Teens are often teased by their peers and friends, and it affects them psychologically. A certain percentage of severely affected teens often have suicidal thoughts,” he says. “Even adult patients don’t talk about it with their families.”

Often, the clinical consultation with the doctor is the first that parents have heard of gynecomastia.

Parents are usually worried only about their child’s safety, he adds. They tend to approve the surgery after being assured the risk is low and understanding how it will benefit their child.

One of Puah’s adult patients, David (not his real name), was initially concerned that the chest enlargement meant a more serious health issue.

He did not tell his wife about consulting the doctor or even about going for surgery in 2025 until the procedure was over.

He did not want her to worry. It was also frustrating for the 45-year-old to live with gynecomastia.

“I’m not fat. I’m quite fit, but even after training, I couldn’t get the ideal shape that I wanted in that area,” he says. “It was irritating.”

The surgery has helped his confidence, he adds. “Everything is better now. I wish I had gone to the doctor sooner. ”

Michael, who is also one of Puah’s patients, found it difficult to confide in friends and family about his gynecomastia. His parents found out about it only when they visited the doctor with him in 2026.

Michael had known about his condition for a decade. He began looking for information about it in his teens, when his chest remained puffy despite his efforts at losing weight through eating right and going to the gym regularly.

“No matter what I did, my chest remained the same size,” he recalls. “The leaner I got, the worse it looked.”

It was not physically painful, but people noticed the puffiness when he took off his shirt. “During national service, people would point out that my chest was lumpy,” he says. “I used to slouch a lot because I wanted to hide my condition.”

He grew more confident in his body after working out. He also revealed his condition to three close friends who worked out regularly. Their acceptance helped his self-esteem.

“A lot of my clothes were very loose and dark in colour. I would never wear any light-coloured clothing because that would make my chest stand out.”

The surgery has changed how he moves through the world.

“Now I don’t have to be picky about what I wear. I just wear whatever I want,” he says. “I don’t have to be conscious about how I’m sitting or standing.”