The male breast

Gynaecomastia

Idiopathic

Hypertrophy of the male breast may be unilateral or bilateral. The breasts enlarge at puberty and sometimes present the characteristics of female breasts (Fig. 46.41).

Hormonal

Enlargement of the breasts often accompanied stilboestrol therapy for prostate cancer — now rarely used. It may also occur as a result of a teratoma of the testis, in anorchism and after castration. Rarely it may he a feature of ectopic hormonal production in bronchial carcinoma and in adrenal and pituitary disease.

Associated with leprosy

Gynaecomastia is very common in men suffering from leprosy. This is possibly because of bilateral testicular atrophy, which is a frequent accompaniment of leprosy.

Associated with liver failure

Gynaecomastia sometimes occurs in patients with cirrhosis due to failure of the liver to metabolise oestrogens. It is associated with drugs that interfere with the hepatic metabolism of oestrogens, such as cimetidine.

Gynaecomastia may occur in patients with Klinefelter’s syndrome, a sex chromosome anomaly having XXY trisomy. It is also seen with certain drugs such as cimetidine, digitalis and spironolactone.

  Treatment

Provided the patient is healthy and comparatively young, reassurance may be sufficient. If not mastectomy with preservation of the areola and nipple can be performed.

Carcinoma of the male breast

Carcinoma of the male breast (Figs 46.42 and 46.43) accounts for less than 2 per cent of all cases of breast cancer. The known predisposing causes include gynaecomastia and excess endogenous or exogenous oestrogen. As in the female it tends to present as a lump and is most commonly an infiltrating ductal carcinoma.

Treatment

Stage for stage the treatment is the same as for carcinoma in the female and prognosis depends upon stage at presentation. Adequate local excision, because of the small size of the breast, should always be with a mastectomy