Male Breast Symptoms

 

This guideline applies to males over 18 years.

 

Male breast cancer:

• Breast cancer is rare in men and usually presents aged over 50.
   
• Breast cancer in men – unless presenting with a subareolar lump, investigate breast lumps in men the same way as in women.

 

Gynaecomastia:

• Gynaecomastia is enlargement of breast tissue and is defined as the presence of >2cm of palpable, firm subareolar gland and ductal breast tissue.
   
• It can occur at any time
   
• Medication accounts for 25% of all cases in adult men
   
• Pseudogynaecomastia – often seen in obese men and refers to fat deposition without glandular proliferation.

 

 

Male breast cancer:

• Previous Klinefelter’s syndrome, chest wall radiation or finasteride use.
   
• High risk family history of breast or ovarian cancer
   
• 50 yrs + with a breast lump.
   
• < 50 years with a non-subareolar lump or subareolar lump (with normal Ix)

 

 

 

Symptom History:

• Breast lumps – duration, changes,
• Nipple changes – colour change, ulceration, bloody/serous, spontaneous or provoked, nipple inversion/distortion
• Breast pain

 

Personal history:

• Previous breast disease/investigations
• Klinefelter’s syndrome
• previous chest wall radiation or finasteride use.
• Significant family history (see Familial Breast and Ovarian Cancer)

 

Gynaecomastia

• Medications causing gynaecomastia -digoxin, spironolactone, anti-androgens, antipsychotics, amiodarone
• Cannabis use
• Past or prolonged use of anabolic steroids
• Alcohol
• Other causes – hyperthyroidism, cirrhosis, CKD, hypogonadism, obesity

 

Examination:

Subareolar lump: testicular examination

Gynaecomastia – cirrhosis

 

 

 

• Men under 50 years with subareolar breast lump:

Bloods – LFTs, TFTs, prolactin, bHCG, AFP, testosterone, oestrogen, SHBG, gonadotrophins, free androgen index.

Note -if the patient has a history of Klinefelter’s syndrome, chest wall radiation, or finasteride use, do not delay referral whilst waiting results.

 

• Men under 50 yrs with axillary lump:

Urgent or routine ultrasound (depending on differential diagnosis).

 

• Gynaecomastia:

Bloods – U&E, LFTs, TFTs, LH, FSH, prolactin, testosterone (preferably 9am), oestrogen,

 

 

 

Gynaecomastia:

• Pseudogynaecomastia (due to fat deposition) – advise weight loss
   
• Hyperprolactinaemia/hypogonadism – refer endocrinology
   
• Infant gynaecomastia– reassure
   
• Adolescent gynaecomastia – Reassure, give pubertal gynaecomastia leafletand re-assess adolescent patient every 6 months

 

 

 

There is no advice and guidance service for breast surgery but there is a service for endocrinology.

 

 

 

Male breast lump with abnormal blood results:

Refer urgent or routine endocrinology depending on the presentation.

 

2ww criteria:

• >50 yrs male with a breast lump.
• < 50 years with a non-subareolar lump or a subareolar lump (with normal Ix or history of Klinefelter’s syndrome, chest wall radiation, or finasteride use)

 

Gynaecomastia:

If proven gynaecomastia the surgical treatment cannot be offered on the NHS as this condition is considered a procedure of low clinical priority. See information on procedures of limited clinical benefit.

 

 

 

For professionals:

• NHS Royal Cornwall Hospitals – Breast Webinar 2022 [video: 1 hour 17 minutes]
• NICE: Clinical Knowledge Summaries (CKS) – Breast Cancer: Recognition and Referral
• NICE Guidance – Suspected Cancer: Recognition and Referral – Breast Cancer

 

For patients:

• Breast Cancer Now:
  • Breast Lumps and Benign (Not Cancer) Breast Conditions
  • Information and Support
• CoppaFeel – Information and Resources
• pubertal gynaecomastia leaflet

 

 

 

Review date	12 January 2024
Next review date	12 January 2026
Clinical editor	Dr Madeleine Attridge
Contributors	Mr Iain Brown (Consultant Breast surgeon) Miss Polly King (consultant Breast surgeon) Dr Rebecca Osborne (GPwSI Breast)