Breast Lumps in Males

Causes of Breast Lump in Males

1. Gynaecomastia

   • Physiological Gynaecomastia: Common in neonates and senile individuals (above 50 years).
   • Pubertal Gynecomastia: Common in adolescents (10 to 14 years) due to hormonal imbalances.

2. Other Causes

   • Breast Malignancies: Uncommon but should not be overlooked.
   • Gynecomastia in obese people: Often related to obesity and fat tissue proliferation.
   • Other Causes: Lipoma, sebaceous cysts, fat necrosis, and hematomas.

Causes of Gynaecomastia

1. Physiological Gynaecomastia

   • Neonatal Gynaecomastia: Common in small children.
   • Senile Gynaecomastia: Occurs in older men above 50 years.
   • Pubertal Gynecomastia: Common in adolescents (10 to 14 years).

2. Pathological Gynaecomastia

   • Increased Estrogen Production: Testicular tumors are a key concern.
   • Decreased Testosterone Production: Liver problems, Klinefelter syndrome, chronic kidney disease, mumps, trauma to the testis, hypogonadism, and hyperprolactinemia.

Investigations

1. Routine Studies

   • Liver Function Test: Assess for liver diseases.
   • Electrolyte and Urea Creatinine (EUC): Evaluate kidney function.
   • Thyroid Function Test (TFT): Check for hyperthyroidism.

2. Hormonal Profile

   • Consider if hypogonadism is suspected.
   • Include LH, testosterone, and estrogen levels.

3. Imaging

   • Testicular Ultrasound: Consider if malignancy is suspected or if features are inconsistent with Gynaecomastia.

Treatment

1. Identifying Underlying Causes

   • Drug-Induced: Discontinue causative drugs.
   • Hyperthyroidism: Treat with antithyroid medications.
   • Testicular Tumors: Refer for further evaluation and potential hormonal or surgical treatment.

2. Non-Pathological Gynaecomastia

   • Wait and Watch: Reassure the patient and monitor every six months.
   • Analgesia: Prescribe for associated breast pain.
   • Surgery: Consider for cosmetic reasons if Gynaecomastia persists.

3. Pharmacotherapy

   • Estrogen Receptor Modulators: Tamoxifen and Raloxifene.
   • Use in drug-induced or persistent pubertal gynecomastia.

4. Surgery

   • Reserved for longstanding symptomatic Gynaecomastia or cosmetic reasons.
   • Options include suction lipectomy and subcutaneous mastectomy.