A 38-year-old male engineer presented to Dr Pek with symptomatic growth of his chest/breast area. Since puberty, he complained of unusually prominent chest tissue around his nipple and areolar region. This had worsened gradually over the years, with the left side being slightly worse than the right. Occasionally, he would feel tenderness on deep palpation of his chest tissue and had suffered minor abrasions from his regular clothing over his nipple region as well. More importantly, he felt constantly conscious of his attire and was especially embarrassed to be topless in an outdoor setting such as the beach or swimming pool area. He was otherwise healthy, maintained a healthy diet and exercise regime and was not obese.

On clinical examination, the patient was found to have Rohrich Grade 2 Gynecomastia. There was a significant excess of both glandular breast tissue and fatty tissue, and the glandular component was tender on deep palpation. A detailed physical examination and hormonal panel workup did not reveal any other significant hormonal abnormalities.

The patient was offered a minimally invasive method of removing the excess breast tissue and improving the contour of his chest. Because of a significant component of glandular breast tissue under the nipple-areolar complex, the patient required two small, well-hidden incisions to effectively remove all the breast tissue and achieve the ideal contour of his chest. After detailed discussion and evaluation, the patient was keen to proceed with surgery to treat his gynecomastia condition.

Surgery was performed as a day surgery procedure, which took approximately 1.5 hours. Under deep sedation, the excess fatty tissue was removed through liposuction techniques through a tiny stab incision near the armpit. A second small incision on the border of the areolar was employed to excise the remaining fibrous breast tissue. Meticulous closure helped to allow the scar to heal smoothly and remain less obvious. Pressure garments were applied at the end of the procedure. Routine histopathology testing of the removed fibrous breast tissue was performed, which showed no signs of any malignant changes.

During the recovery phase, the patient had manageable pain well controlled with oral painkillers for the first few days. The sutures were removed on the 7th post-operative day, and any related bruising and swelling settled after the first couple of weeks. He resumed light exercises from thereon and proceeded on to upper body exercises from the 4th week onwards.  The patient was compliant with his pressure garments, which helped him achieve a quick and seamless recovery. The surgery helped the patient relieve his symptoms and improve his chest contour. Most importantly, it helped restore his confidence, as he felt more at ease with his appearance.

Surgeon: Dr Pek Chong Han