Diseases of the Male Breast
Gynecomastia, or overdeveloped breast tissue, is the most com-mon breast condition in the male. Adolescent boys can be affected by this condition because of hormones secreted by the testes. Gynecomastia usually subsides in 1 or 2 years, but it can occur before or after puberty and in elderly men. It is usually unilateral and presents as a firm, tender mass underneath the areola. In adult men, gynecomastia may be diffuse and related to medications (ie, digitalis, reserpine, ergotamine, ranitidine, and phenytoin). Pain and tenderness are initial symptoms. Treatment depends on the man’s feelings and preference. Observation is acceptable because it may resolve on its own; surgical removal of the tissue through an incision around the areola is another option. Liposuction of the tissue done by a plastic surgeon, another option, yields a pos-itive cosmetic result.
Cancer of the male breast accounts for 1% of all breast cancers; about 1,500 new cases of breast cancer and 400 deaths due to breast cancer occur annually (ACS, 2002b). Symptoms can in-clude a painless lump beneath the areola, nipple retraction, nipple discharge, or skin ulceration. Diagnostic tests and treatment modalities are similar to those used for women. The average age of the patient at the time of diagnosis is 60 years, but it can occur in younger men, especially if there is a genetic link to the disease, because there may be a relationship to BRCA-2 in men with breast cancer. Risk factors may include a history of mumps orchi-tis, radiation exposure, and Klinefelter’s syndrome (a chromo-somal condition reflecting decreased testosterone levels).
Detection usually occurs well into the disease because cancer of the breast is not a common concern among men. Therefore, treatment generally consists of a modified radical mastectomy. If the pectoralis muscles are involved, a radical mastectomy is indi-cated. Radiation therapy may be used postoperatively. Prognosis varies depending on the stage of disease at diagnosis. Bone and soft tissue are the most common sites of advanced disease and metastasis. Orchiectomy (removal of the testes), adrenalectomy (removal of the adrenal gland), and hypophysectomy (removal of the pituitary gland) may be used in advanced disease, but anti-hormonal agents are preferable because they are less invasive and disfiguring.