I am a man but I think I may be developing breasts – what do I do?
Professor Philip J Drew
BSc MBBS MD(Hons) MS FRCS (Eng) FRCS (Glasg) FRCS (Ed) FRCS (Gen)
Professor / Consultant Breast Surgeon
There are two main reasons why a man may develop a lump in the breast. Very rarely this can be a sign of breast cancer but much more frequently it is due to a condition known as GYNAECOMASTIA. Either way all breast changes in a man or woman should be investigated appropriately.
Unlike in women breast cancer in men is rare. However the signs are similar to those in women i.e. a lump in one breast, distortion of nipple away from the centre, skin tethering, bloody nipple discharge, palpable lymph nodes in the armpit etc. A family history of breast cancer is important both in female and male relatives but is not essential. It is managed in a similar fashion to female breast cancer.
Gynaecomastia (male breast growth) is much more common. Indeed in some groups the presence of some breast growth is more common than not. Particularly in young teenage boys the presence of some breast growth and even nipple discharge is very common but usually resolves spontaneously before the age of 18 years. Significant breast growth should be investigated as a small percentage can be due to an underlying hormonal abnormality or genetic issue. There are surgical treatments available if the gynaecomastia is causing significant problems but it is generally best to wait until it resolves spontaneously and thus to treat only severe or persistent cases. The latter group is known as persistent pubertal gynaecomastia and represents only about 10% of those teenage boys who initially developed gynaecomastia.
Gynaecomastia developing as a new finding in young men should always be investigated. Various testicular problems and other hormonal imbalances – either from a disease process such as liver, thyroid or kidney disease or from the use of substances such as anabolic steroids or other prescribed medication can manifest as gynaecomastia in the young adult although as with pubertal gynaecomastia a cause is not always found. There is also a known benign genetic predisposition in some families.
In the male over 45 years of age gynaecomastia once again becomes more common. This is probably due to the reduction in testosterone that occurs at around 1% a year after the age of 35 although obesity, medication – especially for prostate problems and other diseases can also play a role. In some cases testosterone can fall to such a low level that testosterone replacement may be a consideration. Whilst still rare breast cancer is also more common in elderly men and those taking the drug Finesteride for benign prostatic hypertrophy should be particularly aware of any changes in the breast as there is some evidence that breast cancer increases with this group of drugs.request an appointment