Symptoms

Lumps in the breast are usually noticed by the man by chance and not during a regular self-examination. Sometimes large findings are to be expected here, which are already visible on external examination. Occasionally also pain leads to a detailed examination of the breast, whereby newly developed space demands are discovered. Warning signs include palpable hardening, fluid secretion from the nipple or redness and inflammation of the skin over the breast.

Diagnosis

The basis for diagnostics in the context of a lump in the male breast is always the palpation. The doctor will try to classify the findings more precisely by palpation. In addition to the size and consistency of the lump, the physician will also check for pressure pain and its ability to move in relation to the skin or deeper lying muscle tissue.

Following the physical examination, an X-ray examination of the breast (mammography) can be performed. In this procedure, the soft breast tissue is x-rayed, which may reveal other lumps on the x-ray film that were not detected during the palpation. Due to the structure of the lumps shown on the film, it may already be possible to draw a conclusion about the type of disease.

Another imaging method is ultrasound, which does not provide the desired clarity for all clinical pictures. A punch biopsy can be performed to establish a final diagnosis and to check whether the mass found is malignant or benign. For this purpose, a fine hollow needle is inserted through the skin into the lump and the tissue thus removed is examined under the microscope.

Therapy

The therapy of a lump in the breast naturally depends on its cause. A lump in the breast does not necessarily mean cancer. There are also a number of benign causes in men that do not require surgical removal.

If a malignant tumor of the breast tissue is ruled out, a real gynecomastia does not necessarily have to be surgically removed. In some cases, however, it can be so cosmetically disturbing that the person concerned wishes to have it removed. In such cases, after exhausting conservative methods, such as a change in diet and medication, it is advisable to remove the excess glandular or fatty tissue through a small incision at the nipple.

If cysts are present, surgical removal is usually not indicated in the case of benign findings. However, if a cyst is painful or the person affected is psychologically impaired by its presence, it can be punctured under ultrasound control and the fluid contained in it removed. If a cyst develops as a result of a malignant process, a decision must be made on surgical removal and on an individual further procedure.

Since lipomas are benign tumors, treatment is only necessary for cosmetic reasons. Pressure on surrounding tissue, vessels or nerves can also cause pain. Removal is only possible by surgery and must result in the complete removal of the lipoma, since remaining cells of the tumor can grow again.

The surgical removal should be carefully considered, since the inevitable surgical scars are usually more prominent than the tumor itself. In most cases, there is no indication for surgery when a fibroadenoma is diagnosed, but even with this clinical picture, the clarification of a possibly malignant finding must be carried out urgently. The diagnosis is made after palpation, sonography (ultrasound) and a punch biopsy, which allows an assessment of the malignancy of the previously discovered mass.

Whether surgery is necessary is decided according to the criteria of breast size, age, growth rate and location of the lump. For both men and women, the cosmetic impairment is the most important consideration. It should be noted that a rapidly growing lump should be operated on at an early stage in order to keep the soft tissue defect caused by the operation as small as possible.

Local problems are usually caused by the displacing growth of the space requirement and the associated aesthetic problems, as well as pain caused by pressure on surrounding structures. In contrast to the woman, no specific treatment is possible for the man’s mastopathy.Pain can be treated with non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or with paracetamol. In case of a mastopathy with nodularity, an examination of the tissue by biopsy or even the complete removal of the nodule with subsequent tissue examination should be considered. In cases with pronounced symptoms or with a tendency to repeated mastopathies, the entire mammary gland can be surgically removed. The decision about a surgical procedure is made in a detailed doctor-patient consultation.