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Gynecomastia in Singapore

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What is Gynecomastia?

Gynecomastia is a condition where men develop enlarged breast tissue. This can affect one or both breasts and may cause discomfort or self-consciousness. The condition is often associated with hormonal imbalances, particularly an increase in oestrogen levels or a decrease in testosterone levels.

Types of Gynecomastia

Understanding the types of gynecomastia can help in identifying the condition and seeking appropriate treatment. Here are the main types of gynecomastia:

Physiological Gynecomastia
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This type occurs naturally at different stages of life due to hormonal changes:

Puberty: Teen boys might experience breast tissue growth during puberty due to fluctuating hormone levels.

Older Age: In older men, gynecomastia can occur due to a decrease in testosterone levels and a relative increase in estrogen levels.

Pathological Gynecomastia
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This type is linked to underlying health issues or the use of specific medications:

Medications: Certain drugs can cause gynecomastia, including anti-androgens (used for prostate conditions), anabolic steroids, some antidepressants, and medications for heart conditions.

Health Conditions: Diseases like hyperthyroidism, kidney failure, liver disease, and tumours (testicular, adrenal, or pituitary) can cause gynecomastia.

Pseudogyne­comastia
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This condition differs from true gynecomastia as it involves fat accumulation rather than an increase in glandular breast tissue. It’s often seen in overweight or obese people and can be managed with weight loss and exercise.

Causes of Gynecomastia

Gynecomastia can result from several underlying factors, primarily involving hormonal imbalances. Common causes include:

Hormonal Imbalances

Gynecomastia often occurs due to an imbalance in oestrogen and testosterone levels. Increased oestrogen or decreased testosterone can lead to the development of breast tissue.

Medications

Certain medications can cause gynecomastia as a side effect. These include anti-androgens used in prostate cancer treatment, anabolic steroids, some antidepressants, anti-anxiety medications, and certain antibiotics.

Health Conditions

Various health conditions can contribute to gynecomastia, such as:

Hypogonadism: Disorders that reduce testosterone production, such as Klinefelter syndrome or pituitary insufficiency.

Hyperthyroidism: Excess thyroid hormone production can affect hormone balance.

Kidney Failure: Chronic kidney disease and dialysis can alter hormone levels.

Liver Disease: Liver cirrhosis and other liver diseases can lead to hormonal imbalances.

Symptoms of Gynecomastia

Common symptoms include:

Enlarged Breast Tissue
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The primary symptom of gynecomastia is the enlargement of the breast gland tissue. This can occur in one or both breasts and may present as a rubbery or firm mass that starts beneath the nipple and spreads outward over the breast area.

Breast Tenderness
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Men with gynecomastia often experience tenderness or sensitivity in the breast tissue. This discomfort can range from mild to severe and may be accompanied by pain, especially when touching the affected area.

Asymmetry Between Breasts
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Gynecomastia may cause asymmetry between the two breasts, with one breast appearing larger than the other. This can be particularly noticeable and may contribute to feelings of self-consciousness.

Swelling
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Some men with gynecomastia may experience general swelling in the breast tissue, which can be accompanied by a feeling of fullness or heaviness in the breast area.

How is Gynecomastia Classified?

Gynecomastia can be classified based on how much the breast tissue has grown. Here’s the classification system:

Grade I: Small growth around the nipple area that is not very noticeable.

Grade II: Moderate growth that extends beyond the nipple area without excess skin. The edges of the breast tissue blend into the chest smoothly.

Grade III: More significant growth with some extra skin. The breast tissue is more noticeable and creates a visible shape.

Grade IV: Large growth with a lot of extra skin, making the breasts look similar to female breasts. This usually requires surgical treatment to correct.

How to Do a Self-Check for Gynecomastia?

If you're concerned about gynecomastia, performing a self-check can help you understand what's going on with your body. Here’s how you can do it:

Find a Comfortable Space
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Stand in front of a mirror in a well-lit room so you can see your chest clearly.

Visual Inspection
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Look at your chest for any visible changes. Note if there is any swelling, asymmetry, or changes in the nipple area.

Feel for Lumps
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  • Use the pads of your fingers to gently press around the nipple area on each side of your chest.
  • Move your fingers in a circular motion, feeling for any firm or rubbery lumps. Gynecomastia often presents as a disk-shaped lump behind the nipple.
  • Check if the lump is tender or painful to touch.
Check Both Sides
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Gynecomastia can occur in one or both breasts, so make sure to examine both sides of your chest thoroughly.

Assess the Tissue
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Determine if the enlargement feels like breast tissue (firm and rubbery) or fat (softer and more diffuse). Pseudogynecomastia, caused by fat accumulation, feels different from true gynecomastia, which involves glandular tissue.

Look for Other Symptoms
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Pay attention to any discharge from the nipple, changes in skin texture, or any additional pain or discomfort.

Diagnosis of Gynecomastia

Diagnosing gynecomastia involves a combination of medical history, physical examination, and diagnostic tests to identify the underlying cause. The process typically includes the following steps:

Medical History

Your plastic surgeon will typically inquire about:

  • Duration and progression of your breast enlargement.
  • Associated symptoms, such as pain or nipple discharge.
  • Medication use, including over-the-counter.
  • Presence of underlying health conditions, such as liver or kidney disease.
  • Family history of gynecomastia or related hormonal disorders.

Physical Examination

A thorough physical examination is conducted to assess the breast tissue and identify any abnormalities. The examination focuses on:

  • Evaluating the size and consistency of the breast tissue.
  • Checking for tenderness and any signs of nipple discharge.
  • Examining the testicles for any masses or abnormalities that could indicate a hormonal imbalance.

Diagnostic Tests

To confirm the diagnosis and identify the underlying cause, several diagnostic tests may be conducted:

  • Blood Tests: These tests measure hormone levels, including testosterone, oestrogen, and other relevant hormones, to identify imbalances.
  • Mammography: An imaging test that helps distinguish gynecomastia from other conditions, such as breast cancer or fatty tissue enlargement.
  • Ultrasound: This imaging test provides detailed pictures of the breast tissue and can help identify any lumps or abnormalities.

Treatment Options for Gynecomastia

Gynecomastia Surgery
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This surgical option involves removing the excess breast tissue to restore a flatter chest contour. It can significantly improve physical appearance and alleviate discomfort. Gynecomastia surgery typically takes about 1-2 hours to perform and is considered an outpatient procedure.

The Treatment Procedure for Gynecomastia Surgery

The procedure typically involves:

  • Anaesthesia: Local or general anaesthesia to ensure comfort.
  • Incisions: Small incisions around the areola or in the armpit area.
  • Tissue Removal: Removal of excess glandular tissue and fat.
  • Suturing: Closing the incisions with sutures.
Recovery and Aftercare for Gynecomastia Surgery

Post-surgery care typically includes:

  • Rest: Adequate rest to promote healing.
  • Pain Management: Taking prescribed medications to manage pain.
  • Avoiding Strenuous Activities: Limiting physical activities to avoid complications.
  • Follow-up Appointments: Regular check-ups to monitor recovery.
Risks of Gynecomastia Surgery

Undergoing surgery to correct gynecomastia involves certain risks, just like any other surgical procedure. Here are some potential risks to consider:

  • Infection: Post-surgical infections can occur, requiring antibiotics or further treatment.
  • Scarring: There may be visible scars from the incisions, which can vary in size and visibility depending on the surgical technique used.
  • Bleeding or Hematoma: Excessive bleeding or the accumulation of blood (hematoma) can occur after surgery, possibly necessitating additional procedures.
  • Changes in Sensation: Some patients experience changes in nipple or breast sensation, which can be temporary or permanent.
  • Asymmetry: There might be unevenness in the appearance of the chest if the tissue removal is not symmetrical.
  • Adverse Reaction to Anaesthesia: As with any surgery, there are risks associated with anaesthesia, including allergic reactions or other complications.
Cost of Gynecomastia Surgery

In Singapore, the cost for this procedure typically ranges from SGD 6,000 to SGD 12,000. Several factors influence this range, including:

  • Surgeon’s Fees: The fees charged by your surgeon may vary.
  • Surgery Fees: The overall cost of the surgical procedure itself.
  • Anaesthesia Fees: The type of anaesthesia (local or general) and the anesthesiologist’s fees contribute to the overall cost.
  • Post-Surgery Care: This includes follow-up consultations, medications, and compression garments, which are often part of the overall price but can vary.
Liposuction
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Liposuction is used to remove excess fat from the breast area. This technique is effective when there is more fatty tissue present. The recovery process is typically quite tolerable, with patients usually able to return to work or school within several days after the procedure.

Treatment Procedure for Liposuction

Liposuction involves:

  • Anaesthesia: Local or general anaesthesia to ensure comfort.
  • Insertion of Cannula: A thin tube is inserted to suction out excess fat.
  • Suctioning: Fat is suctioned out, contouring the chest area.
  • Completion: Incisions are closed with sutures.
Recovery and Aftercare for Liposuction

Recovery involves:

  • Compression Garments: Wearing garments to reduce swelling and support the chest.
  • Managing Swelling: Using cold compresses and prescribed medications.
  • Following Care Instructions: Adhering to specific instructions from the plastic surgeon.
Risks of Liposuction

While liposuction is a less invasive option for treating gynecomastia, it still carries certain risks. Here are some potential complications to be aware of:

  • Infection: As with any surgical procedure, there is a risk of infection at the incision sites, which may require antibiotics or further treatment.
  • Asymmetry: There may be uneven results, with one side of the chest looking different from the other, requiring additional corrective procedures.
  • Contour Irregularities: The skin surface might appear uneven, wavy, or bumpy after liposuction, especially if too much or too little fat is removed.
  • Changes in Sensation: Some patients experience temporary or permanent changes in skin sensation, including numbness or tingling.
  • Fluid Accumulation: Fluid pockets (seromas) can form under the skin, which might need to be drained.
  • Adverse Reaction to Anaesthesia: Although rare, some individuals may have adverse reactions to the anaesthesia used during the procedure.
  • Scarring: While incisions are small, there can still be some scarring, which may vary in visibility depending on individual healing.
Cost of Liposuction

For liposuction, the cost in Singapore typically ranges from SGD 4,000 to SGD 10,000. Key factors that determine the cost include:

  • Surgeon’s Fees: The fees charged by your surgeon may vary.
  • The Procedure: The amount of fat to be removed and the complexity of the procedure can affect the price.
  • Technology Used: Techniques such as VASER or laser-assisted liposuction may incur higher costs due to specialised equipment and expertise.
  • Post-Surgery Care: This includes follow-up consultations, medications, and compression garments, which are often part of the overall price but can vary.

MediSave Claims for Gynecomastia Surgery

Singapore Citizens (SC) and Permanent Residents (PR) can use MediSave to claim gynecomastia surgery costs in Singapore, but eligibility and claimable amounts depend on the procedure type and the patient’s MediSave balance. For the surgery to qualify, it must address significant symptoms or complications and be performed in a licensed facility by an accredited surgeon.

Insurance Claims For Gynecomastia Surgery

Insurance coverage for gynecomastia surgery depends on the patient’s condition and the insurance policy terms. If deemed medically necessary due to pain or health issues, insurance may cover part or all costs. Check with your medical insurance to see if your policy includes this coverage and ensure you provide comprehensive medical documentation. Consulting your surgeon can help you understand the steps to secure insurance coverage.

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    Frequently Asked Questions (FAQ)

    Is gynecomastia surgery safe?

    Gynecomastia surgery is generally safe when performed by a qualified surgeon. However, like any surgery, it carries certain risks and potential complications, which should be discussed with the surgeon.

    What can I expect during recovery from gynecomastia surgery?

    Recovery involves managing discomfort with medications, wearing a compression garment, following wound care instructions, and avoiding strenuous activities for several weeks. Regular follow-up appointments are necessary to monitor healing.

    How long does it take to recover from liposuction for gynecomastia?

    Recovery from liposuction typically takes a few weeks. Patients may experience swelling, bruising, and discomfort, which gradually subside. Wearing a compression garment and following the surgeon’s aftercare instructions are crucial for optimal recovery.

    Are the results of gynecomastia treatment permanent?

    Results are usually long-lasting, especially if the underlying cause is addressed and a stable weight is maintained. However, changes in weight or hormonal fluctuations can affect the results over time.

    Can gynecomastia recur after treatment?

    Gynecomastia can recur if the underlying cause is not resolved or if there are significant hormonal changes. Maintaining a healthy lifestyle and managing any ongoing medical conditions can help prevent recurrence.

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