For the Singaporeans: SGH

[abdrah]

Since such as thread is a rarity here, and I've received numerous emails from people residing in Singapore regarding surgery at SGH, I'll be posting my surgery experience here for the benefit of others.

A little background. Had what seemed like one-sided gynecomastia since 17. I'm 180cm (5' 11") and 75kg (165 pounds), so I'm not overweight. The doctor advised me to opt for bilateral surgery (both sides) for symmetry as there have been cases of people going for unilateral surgery and not being happy with the result. In the picture, the lighting makes it seem barely noticeable, but under direct sunlight.. It's really obvious. Have not gone near a swimming pool ever since NS.

My surgery was conducted by Prof. Tan KC of SGH. He's a consulting doctor and the procedure was called "Microdebrider KIV Open breast excision". Basically, the microdebrider is first used to remove the fatty tissues and gland (if possible) through minute incisions at the side, which is similar to liposuction. If gland removal fails, a peri-areolar incision is then made to remove the gland.

One week prior to the surgery, you'll have to undergo a Pre-Operative Assessment for a blood test and chest X-Ray. You'll also speak to an anasthetist on your allergies, previous med history etc.

Pre-surgery:



Reported at 7am to the Same Day Admissions (SDA) Centre, underwent all the paperwork, a check by a doctor to assess your health and you change into the kimono-style garment. You declare your belongings to a nurse and take a lift up to the Operating Theatre (OT) level. You're made to lie on a bed and wheeled to the prep room outside the OT. Feels weird being wheeled on a bed by two nurses.

At 8.30am, an IV is inserted (usually on your left arm, according to the nurse) in the prep room after a small local anasthetic has been applied. Prof. Tan KC came in, used a marker to mark the areas to be removed and you're wheeled into the OT. There was some small talk with the anasthetist and a short sharp pain shot into my left arm as the GA is applied via the IV. The anasthetist was asking me to explain what the pain was like, whether it was travelling through my left arm. I was talking and the room was spinning and black-out..

Awoke at 10.20am while being wheeled to the recovery room. I remembered having a nice dream but not being able to recall what. The nurse in the recovery room told me the time is 10.20am. The female nurses at SGH are pretty cute IMO..  

Left to lay there for sometime and was then transferred to the ward bed and warded in the subsidised B2 ward, where I spent the whole day recovering. There was no pain at all, just a tight foam wrap with elastic bands.

Post-op:



The nurses kept asking whether I needed any pain meds. I refused as there was no pain. The nipple and surrounding areas have no feeling too. Was warded for the night and discharged the next day. No drains were placed. The doctor said 150 mil was removed from each side, with a little bit more from the left side due to the gland. No excision was made as the gland was successfully removed using the microdebrider.

Downside is.. The foam pad is itching like crazy! But what is one week compared to the past decade of psychological suffering. The next appointment is next week, to replace the tight foam pad with a tailored compression garment. Other than that, the feeling is generally sore around the chest area.

Anyone have any other questions you might wanna ask, just PM me. Best regards.

[maestro]

hi buddy, how much did the whole op cost?

[abdrah]

2.3k dude..

[saranghaeyo]

now notice you posted here.
I need to book for my 2nd appointment.
I think it seems yours condition is better than mine.

[abdrah]

Got my first bathe today after the binder was removed! The itch was killing me.

Went to SGH to fit the pressure garment. Unlike the Design Veronique 2nd-Stage garment that I bought (there's a SG distributor, but it costs $180 per piece. PM me for details. But I'd advise you to buy it and ship it to SG to take advantage of the weak greenback), the SGH custom tailored pressure garment doesn't really provide enough pressure to the chest area. Instead its compressing my biceps and abdominals. Lol.   I'll have to see whether I have the finances to get the 1st-stage pressure garment from DV.

There was abrasion on my left nipple, which had to be dressed up in Clinic J. My right is flat like a board, but my left has some bumps which I assume is scar tissue since more work was done there.

My chest is still sore and I can't quite lift my hands above my shoulder level. It's been about 9 days post-op so far.

saranghaeyo, book it as soon as you can. It's really a load off your chest.

Some previous pre-op photos I took of my side view.

Left:


Right:


The feminine shape of the chest is kinda obvious in both cases.  

I haven't had time to take pictures as the only time I have without the pressure garment is in the bathroom. Will update soon.

[abdrah]

Update: 11 days post-op.

Went for my consultation earlier. Apparently, a half-areola incision was made on both sides of my chest, with the smaller incision having been made on the right side to remove the smaller gland. The right side has healed nicely.

The left side incision has yet to heal and is still quite bloody. The surgeon told me the hardness is normal. It's the scar tissue forming since the mass was taken out.

Therefore the procedure is liposuction (cannula), microdebridement and glandular excision.

The person who told me that no incision was made wasn't the surgeon. He was wearing scrubs and was among the first few people I spoke to right after my surgery (besides the cute nurse). Hmm..

Front view:


Right view:


Left view:

[abdrah]

Update: 12 days post-op.

Arm movement above shoulders is back at about 85% with some little remaining soreness in the chest.

Went out yesterday and after about 30 mins, it felt as though there was fluid building up on my chest. It felt hard, swollen and heavy as compared to when I'm resting at home, walking to the kitchen, or watching tv. Recovery is still on-going..

My main concern is my left side. The nipple has turned dark brown, but the skin is shedding off slowly. The doctor was stumped as to why the abrasion was occurring. My theory is that the transparent Tegaderm dressing is the main cause of the abrasion.

After the op, the entire surgical site (my chest) is covered with the transparent dressing, then the binder is placed on top of that. I believe some of the Tegaderm had covered part of my left nipple and after a week, when the dressing was removed, it ripped off part of the nipple skin.

This was confirmed the last dressing change when the nurse placed a smaller Tegaderm dressing to cover the left nipple. Part of the dressing was exposed to the tip of my left nipple. When I removed it at home and cleaned the area myself afterwards, the tip of the nipple was red and bleeding.

I believe the Tegaderm dressing, in keeping moisture out (so you can bathe), is also keeping moisture in. This softens your skin, especially the areola region. Combined with the adhesive of the Tegaderm dressing, your areola skin simply comes off. This doesn't occur on normal skin cos none of the skin exposed to the Tegaderm came off.

I'll highlight this to the doctor the next time I see him again.

[maestro]

hey bud, mind sharing some info on the procedures/steps prior to the surgery such as consultation and such, not forgetting medisave or insurance coverage on part of the costs? i've been to a specialist and the amount quoted was really massive....for me atleast. thanks!

[abdrah]

hey bud, mind sharing some info on the procedures/steps prior to the surgery such as consultation and such, not forgetting medisave or insurance coverage on part of the costs? i've been to a specialist and the amount quoted was really massive....for me atleast. thanks!

For the steps prior, for

Citizens and PR: To be eligible for medical subsidies by the govt, you will have to go via the Polyclinic route. Go to the nearest Singhealth Polyclinic and convince the GP to refer you to a plastic surgeon at the hospital of your choice. The subsidy rate should differ for citizens and PRs.

Once at the hospital, the attending doctor (plastic surgery clinic) will ask you questions pertaining to finances, what procedure you wish to take up (unilateral, bilateral). It was down here that the doctor asked me whether I was able to pay the "cosmetic" rate. I told him I came via the Polyclinic route and could not afford the $5000 for "cosmetic". He then sought advice from the senior consultant, who offered to list it under "Medical". The quote then reduced to $3500 iirc.

At the financial assessment room (SGH), the nurse will ask whether you are willing to submit your details for govt means-testing. This is the method the govt disburses subsidies based on your income and living location. If you agree, you sign on 2 forms to indicate compliance. As I'm a student (no income) living in a govt apartment (HDB), the means-testing reduced the estimated bill for $2300 with 2 nights stay in the B2 ward.

The financial assessment will give a total breakdown of the estimated bill and the booked date of surgery. 1 week before your surgery, a deposit has to be paid (computer-decided. my first appointment deposit was $600. my second appointment deposit was $300). Note that my first surgery date was cancelled due to complications in the morning surgery, causing my timeslot to be used up.

I then filled up the enclosed medisave form to pay the rest via medisave. The nurse stated that in "Medical" cases, the doctor will have to write a letter justifying the classification. This letter would also be given to the CPF Medisave office and their approval will be known at a later time.

So, at the current moment, I'm still awaiting the final bill to come. If medisave is approved, then the $2000 would have been paid via that. Otherwise, I would think that the full $5000 would have to be paid up.

Non-citizens: You'd have to pay the full amount as no subsidies are given to you. This is the same case in other countries. Without any option, you'd be better off doing research on holiday surgeries in countries such as Thailand (Dr Poomee has a good rating within this forums).

Best regards.

[abdrah]

Update: 17 days post-op.

The right side is healing up nicely. The incision scar is barely visible. Some residual hardness still remains due to the scar tissue, mostly under the areola. The compression vest takes care of it most of the time, unless I'm bathing.

The left side areola skin is shedding slowly. Prof KC Tan said it's kinda like a sunburn and your skin starts shedding. There were residual bluish-black areas under the left areola a few days ago, which I believe is due to blood pooling. But that has cleared up. The scar tissue on the left is much more significant and the area looks swollen, but not to a bad extent.

By the way, for interested Singaporeans, the bill from SGH just came. The breakdown is as follows. Do note that I was quoted 2.3k total for the surgery after means-testing as a citizen, with the doctor classifying my surgery under "Medical", and not "Cosmetic".

Ward, X-Ray, Laboratory investigations, OT Fees, Surgical Fees, Anasthetist Fee - $3583

Less: Government Grant - $2260

The total added up to $1300, which was totally paid for using my father's medisave. I believe Medisave will approve payment if the "Medical" classification is approved. This would have to be justified by the doctor himself.

Therefore, for Singaporeans suffering from this condition.. Go for it. Don't live with the constant psychological torment caused by this condition. I actually wanted to go for surgery 5 years ago, reached the Polyclinic but turned back for fear of embarrassment. I regret not having done it sooner.

There is nothing to fear with regards to the surgery. The doctors and nurses at SGH will make you feel comfortable, and the procedure felt like 3 minutes! That was how long a nap I felt I took, when in fact under General Anasthesia, the surgery was from 8.30am to 10.20am.

[dextermorgan]

Good day to you,

you mentioned previously that the fees in total was around 2.3k. Why has it only become 1.3k? That's really good news. And has the medisave claim being approved?

All the best to your recovery.

[abdrah]

2.3k was the estimated amount after government grant, however the government grant given was higher than what was expected, thus the payable cost went down to 1.3k. And yes, medisave was successfully used to pay for the 1.3k. I used my dad's medisave btw.

It is important to choose the right doctor who will write in to justify the "Medical" classification for you. I believe most of the doctors at Clinic J are able to, however I have not had any experience with the other doctors (hope not!). So Singaporeans who are consulting with doctors other than Prof. Tan KC, kindly share your experience here for the benefit of the others.

Back in school, I'm starting to notice more and more people are having gynecomastia. Previously, I was so self-conscious about my own problem, I didn't bother looking around. Now, it seems more and more obvious, even in good friends of mine, although theirs seem to be symmetrical (bilateral) and they aren't really bothered by it.

Update: 1 month post-op

Scar tissue on the right side is becoming about the size of a 50-cent coin, under the areola (it's hard, flat and feels different from normal tissue) with constant massage in the bath. The incision scar is barely visible.

On the left, the black areola skin has shed off, but not completely. The lower half still has remnants of the old skin. I'm not rushing to remove it, just letting it dry up and scale off by itself. The scar tissue on the left is quite massive, almost as large as my palm, but its flat, so no problems wearing t-shirts there. There's also some fluid build-up near the sternum. Feels soft and squishy. Arm movement is back to normal, with some residual tightness in the chest area when stretching arms wide out and straight up (I'm wondering how the patients of Dr. Bermant, in this forum, are able to achieve full arm movement and rotation within 14 days! I guess it boils down to the surgeon's technique).

Still have my compression garment on 23/7. Some friends felt the velcro at the back when they tapped my back. I simply brushed it off as a back-aid for a non-existent back problem. No way I'm telling them I used to have moobs.
 

[DrBermant]

On the left, the black areola skin has shed off, but not completely. The lower half still has remnants of the old skin. I'm not rushing to remove it, just letting it dry up and scale off by itself. The scar tissue on the left is quite massive, almost as large as my palm, but its flat, so no problems wearing t-shirts there. There's also some fluid build-up near the sternum. Feels soft and squishy. Arm movement is back to normal, with some residual tightness in the chest area when stretching arms wide out and straight up (I'm wondering how the patients of Dr. Bermant, in this forum, are able to achieve full arm movement and rotation within 14 days! I guess it boils down to the surgeon's technique).

Dead tissue and poor healing will slow down the process. While complications do happen, I have been able to minimize them for my patients. This is critical for a practice that has most of our patients traveling for such great distances. Pushing tissues beyond what they can take will slow the process down even further.

Many of my patients have full movement well before 2 weeks. Yes, it is an issue of technique, skill, and many other factors. It starts out with a passion for documentation of the problem, results, and how I got there, with a constant re-evaluation of my cases and refining the technique continuously. The early after surgery documentation permits me to assess bruising and swelling. The flexing views and movies permit me to evaluate motion. The process continues with a passion for patient education. It is the education of each of my patients that permits me to achieve the result.

Good luck on your healing.

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737

[abdrah]

Thanks for the great insight, Dr. Bermant!

Slightly more than a month post-op now. My nipples are feeling uncomfortable and seem to be hyper-sensitive to the compression garment fabric. Thankful for this forum for the vast amount of information available, so that I know something is not out of the ordinary. So far a few people from Singapore (citizens, PRs and foreign expats) have enquired about surgery at SGH.

Great to know that more and more people are willing to get treatment done for this condition. Best of luck to all!

[troubledman]

Hi Bro,

Congrats...on your successful operation.

I have been living with worser gynecomastia than you....and have tried to live with it. But today, i decided im going for the surgery......i would like to gather some information.

-Was there a need for your family members to sign off any documents for this operation? or it is totally just involving you alone? I would really like to keep the operation a secret if it is possible....

-It is possible to discharge from the hospital just after 1 day?

Thanks