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.
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