Dear Dr. B: Do men get breast problems?
Answer: Male breasts can have same sort of problems as female breasts. These problems are not common. But when they occur they should not be ignored.
In a healthy normal male, the breast is a rudimentary structure. The breast glands are small with fibrous tissue and some fat around the ducts.
The abnormalities of the male breast can be caused by congenital anomalies which may involve the breasts or the nipples. Male breasts do get problems which are inflammatory in nature, similar to what women get.
The most common problem I have seen is called gynecomastia. Gynecomastia is due to formation of firm tender tissue directly under the nipple. It may affect one breast or both breasts. In pseudo-gynecomastia, enlargement of the male breast occurs due to collection of excessive non-tender fatty tissue. Differentiation is important for investigation and management.
Gynecomastia can occur temporarily in 60 to 90 per cent of the newborns because of the passage of estrogen (female sex hormone) through the placenta.
Gynecomastia can occur during puberty. This can be anywhere from the age of 10 and peaking between the ages of 13 and 14. Then it declines during the late teenage years.
Gynecomastia can occur in the adult population as well. This occurs usually between the ages of 50 to 80.
At birth, the breast tissues of both sexes appear identical. The tissues remain dormant during childhood. At the time of puberty, the male and female breast tissues start showing features of different development.
Gynecomastia can be due to chromosomal abnormalities, endocrine function, and consumption of hormones or drug therapy. Fifty per cent of gynecomastia are of unknown origin or due to puberty. About 20 per cent are due to drugs. The rest are due to testicular tumours or poor testicular function or over active thyroid or kidney disease.
Breast cancer is a possibility but very rare in males. The lump is usually hard, non-tender and can be anywhere in the breast. There may be bloody nipple discharge. There may be dimpling of the skin.
How should we investigate?
All patients need full history (including previous medical problems and use or abuse of medications) and full physical examination (especially examinations of the testicles to see if there is a tumor).
If there is nothing significant to find then most teens do not require extensive blood work because most gynecomastia are part of growing up. A periodic follow-up may be advised. In 90 per cent of teenage boys, gynecomastia goes away in less than 3 years.
Gynecomastia can be due to increased production or decreased breakdown of estrogen, which may indicate a hormonal or liver function work-up (blood tests).
In adults, sometimes the problem can be solved by stopping the medications. Rarely, surgery may be necessary to remove the extra breast tissue.
If a breast enlargement is one sided, hard, and nodular, it is very important to perform a biopsy and mammogram to rule out breast cancer.
If gynecomastia is due to disease or tumor then further treatment is required.
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