Disorders of the male breast can affect skin, subcutaneous tissues, stroma, glands, and neurovascular structures. The most common presentation is a nodule or breast enlargement. Gynecomastia, an increase in breast tissue due to an estrogen-testosterone imbalance, is the most common disorder. Other benign and malignant tumors can also occur, including lipomas, cysts, and rare cases of male breast cancer. Evaluation and treatment depends on the underlying cause and may include medications, surgery, or cancer therapies.

1. Disorders of MALE Breast
Dr Ch Radha Siva Bharath

2. • The most common reasons for a man to seek
a consultation are increased breast size,
appearance of a nodule, or pain

3. • Diseases in the male breast can affect the skin
and subcutaneous tissues, stroma and
glandular elements, and neurovascular and
lymphatic structures.
• Although the most commonly encountered
disease entity is gynecomastia, men can
develop many other benign and neoplastic
diseases, including primary breast cancer

4. Skin and Subcutaneous Tissues
• Most common being lesion seborrheic
keratoses
Disorders like epidermal inclusion cysts
(sebaceous cyst)- present as non-tender
palpable round well circumscribed
intradermal / subcutaneous lump ranging
from 1 to 5cms in size.

6. • Other subcutaneous lesions include
hematomas, lipomas and fat necrosis

7. Lipoma Of Breast

8. Lipoma of Breast

9. Fat Necrosis
• It may result from accidental trauma, but most
cases are seen after surgery or radiation therapy.
At mammography it can present as lipid cysts,
coarse calcifications, focal asymmetries,
microcalcifications or spiculated masses
• Fat necrosis presentation varies depending of the
degree of fibrosis associated, so some cases it is
indistinguishable of malignancy and requires
biopsy.

11. Stromal and Glandular Elements
• Gynecomastia is commonly seen in neonates,
adolescents during puberty, and elderly men
who may have increased estrogen and
decreased testosterone levels.

12. • During puberty in boys, levels of oestrogens do increase
(stimulating the growth of breast tissue) but more
importantly there is a major increase in testosterone
levels (antagonising the effects of oestrogen).
• This means that there is a temporary proliferation of
breast ducts and stroma, followed by involution of these
ducts.
• Epithelial hyperplasia, ductal elongation and branching,
proliferation of the periductal fibroblasts, and an
increase in vascularity. The histologic picture is similar in
male and female breast tissue after exposure to estrogen

13. • The terminal lobular units do not develop in
the male breast due to an absence of
progesterone.
• Cooper’s ligaments are also absent in the male
breast

14. • Increased estrogen production and/or action can occur
at the testicular level or at the periphery and is
characterized as follows:
• From the testes - Can be due to testicular tumors or to
ectopic production of human chorionic gonadotropin
(hCG), as is reported with carcinoma of lung, kidney,
gastrointestinal (GI) tract, and extragonadal germ cell
tumors
• From peripheral conversion - Can be due to increased
substrate or increased activity of aromatase, as in
chronic liver disease, malnutrition, hyperthyroidism,
adrenal tumors, and familial gynecomastia

15. Causes
• Increased oestrogen to testosterone ratio

16. • On clinical examination, presenting as a firm,
mobile mass centred under the areola that
can be painful, especially if it has developed
recently .
• It is usually bilateral and asymmetrical (84%).
It is important to examine the patient’s
testicles, as a number of testicular pathologies
and especially tumours can cause
gynecomastia

17. • Can have a very significant psychological
impact on patients, especially adolescent boys
• psychological effects of gynecomastia can
include depression, anxiety, disordered eating,
body dissatisfaction, and reduced self-esteem

19. • Gynaecomastia have been described: nodular,
dendritic, and diffuse glandular pattern in
ultrasound.
• Gynecomastia should be differentiated from
pseudogynecomastia (lipomastia), which is
characterized by fat deposition without
glandular proliferation.

28. • Chance of malignancy?
• Men with Klinefelter syndrome have a 10- to
20-fold increased risk for breast cancer.

29. • Treatment:
1. Stop the cause if there is any obvious reason. In young
age group especially in teenagers , Canabis smoking is
becoming common reason for gynaecomastia.
2. Reassurance of the patient if the condition is idiopathic
as this condition will need at least 1 year to settle.
3. Medical treatment with Tamoxifen (block the oestrogen
by acting as Oestrogen analogue).
4. Surgical options: Usually this option is kept as a last
option and better to be avoided unless it is necessory or
other kind was tried
without success.

30. • There are different kinds of surgery to correct
gynaecomastia depnding on grade and these are:
* Liposuction only for grade 1 gynaecomastia
with no any skin laxity.
* Combination of liposuction with excision of the
central disc through a small periareolar incision.
* In grade 3 gynaecomastia with a fully formed
breast, a complicated surgery is needed to excise
the breast and reduce the
skin is needed.

31. Pseudoangiomatous Stromal Hyperplasia
• (PASH) is a benign proliferative lesion of the
mammary stroma that can present as a palpable
abnormality but that more commonly is found
incidentally on histology of breast biopsy
specimens performed for other indications.
• It rarely presents as a localized mass . Although
not considered premalignant, PASH can recur
locally.
• PASH can be circumscribed or partially
circumscribed on mammography and ultrasound.

32. • If enlarging on imaging or symptomatic, PASH
may be excised with 1- to 2-cm surgical
margins to minimize the chance of recurrence

33. Mastitis With or Without Abscess
• Mastitis is an infection of the breast tissue that
can be complicated by abscess formation.
• Abscesses often can form within areas of duct
ectasia.
• On mammography mastitis often presents with
unilateral breast enlargement with skin and
trabecular thickening.
• With an abscess, an irregular mass with or
without calcifications may be seen and can be
difficult to distinguish from malignancy.

34. • Clinically it presents with Pain, swelling,
reddening of the breast and fever.

37. • In some cases, abscess can mimic gynecomastia,
but the presence of skin thickening suggests an
infection or malignancy and correlation with
clinical history is important to establish the
correct diagnosis.
• Percutaneous drainage of abscesses is often
performed in an effort to improve the
effectiveness of antibiotic therapy;
• However, in refractory cases, surgical excision of
both the abscess and the duct may be necessary.

38. Male breast cancer
• Breast cancer in male accounting for about
only 1% of breast cancers and usually are
detected in men between the ages of 60 and
70 .
• The only problem here is that because there is
no much breast tissue in men, cancer here
tends to invade the surrounding tissue
especially the underlying muscle faster than in
women.

39. • The most common sign of breast cancer in
men is a firm, nonpainful mass located just
below the nipple. Patient can also present
with bloody nipple discharge
• The cancer may cause skin changes in the area
of the nipple. These changes can include
ulceration of the skin, puckering or dimpling,
redness or scaling of the nipple, or retraction
of the nipple.

40. • Advancing age
• A family history of breast cancer, particularly involving the
BRCA2 gene
• Obesity
• Jewish ancestry
• Treatment for prostate cancer
• Klinefelter's syndrome
• Infertility
• Testicular abnormalities ( cryptorchidism, testicular
injury/torsion )
• Radiation exposure
• Alcohol abuse

45. • Types of cancers are same with most common
cancer is infiltrative ductal
carcinoma. Management options are also
same whether the surgical or the adjuvant
treatment after.

46. • Male breast cancer responds quite well to
treatment; the overall 5-year survival rate is
about 60%, but early diagnosis can improve
that substantially.

47. Miscellaneous

48. Jogger's nipple
• Irritation of the nipple is more common than
enlargement of the breast itself.
• Pain, redness, and even bleeding of the male
nipple are fairly common complications of
intense, prolonged exercise — hence the
common names "jogger's" and "marathoner's"
nipple.
• The cause is not running itself but the mechanical
irritation of the runner's shirt rubbing up and
down against his chest, especially in hot, humid
weather.

49. • apply some petroleum jelly to your nipples
before you run

50. • Neoplasms in the breast can originate from
the neurovascular and lymphatic structures,
although these neoplasms are uncommon in
both women and men.
• The most common lymphatic disease is
lymphoma, which can be primary or
secondary in the breast.
• Other benign tumors in the breast include
neuromas, schwannomas, and glomus tumors.

51. • Men may also present with metastasis to the
breast from nonbreast primary malignancies—
most commonly, melanoma, lung carcinoma,
and lymphoma

53. SCHWANNOMA.
• A rare male breast neoplasm arising from
Schwann cells of peripheral nerve sheaths.
• Clinically they present in men as smooth, soft
and painless mass.
• On mammography we see a well-defined and
round/oval mass that on US is well-defined,
hypoechoic and solid mass with variable
posterior enhancement

55. Duct ectasia
• It predominantly involves the retroareolar ducts and is
defined as a non-specific dilatation of one or more
ducts.
• It may be a palpable finding or there may be nipple
discharge.
• Mammograms show dense tubular structures
converging in the areola-nipple complex; they may
have calcifications.
• On ultrasound they are tubular branched structures,
anechoic, full of discharge and that may contain cell
debris; they may be central or peripherally located, the
latter favoring a malignancy

56. Hamartoma
•
• They are benign, mixed, circumscribed lesions that
contain glandular elements, fibrous and fatty tissue.
• It is uncommon, with a 0.1-0.7% reported incidence.
• There may be invasive ductal carcinoma or in situ
ductal carcinoma in remote cases.
• On mammography lesions are ovoid, well
circumscribed with lucencies, dense elements that
represent glandular and fibrous tissue.
• On ultrasound the echotexture may be hyperechoic,
isoechoic or heterogenous

57. Costochondritis
• It is a self-limited condition defined as an
inflammation of the costochondral or
costosternal junction, usually in multiple levels
with no inflammation or induration.
• Pain is elicited with intentional palpation of
the affected cartilage and may irradiate to the
chest wall