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Diseases of the Male Breast - Male breast disease

Diseases of the Male Breast - Male breast disease
Male breast disease includes a wide spectrum of conditions. Many conditions and entities that affect the female breast may also affect the male breast. The spectrum includes:

• male breast cancer 
• gynaecomastia
• pseudogynaecomastia - fat deposition within the breast
• breast lipoma
• epidermal inclusion cysts of the breast
• subcutaneous leiomyoma of breast
• subareolar abscess
• intramammary lymph nodes
• post traumatic fibrosis

The most common breast changes seen in the breast are senescent. As the person ages there is progressive fatty deposition in the breast as well as pectoral muscle volume loss. This has been called pseudogynecomastia. In gynecomastia there is a palpable mass; senescent breast changes in the male do not include a palpable mass.

Male breast cancer

These are invariably infiltrating ductal carcinomas (IDC). The imaging characteristics and clinical manifestations are indistinguishable from the disease in the non male  breast. There is no way of distinguishing the gender of the patient by looking at imaging. This is a scarce disease even in busy breast centres.
The diagnosis is sometimes delayed due to the patient's hesitancy to seek advice. Workup from a radiological point of view is the same as for women including the use of needle biopsy to confirm the diagnosis.

Imaging characteristics of IDC and gynaecomastia

Invariably in gynecomastia there is glandular opacification abutting the posterior aspect of the areola. IDC can occur anywhere in the breast. You will not find gynecomastia and should not consider it as a diagnosis if the area of opacification is remote from the posterior aspect of the areola. Skin thickening and tethering are  not part of gynecomastia. The ultrasound images of gynecomastia are pathognomonic; there is a hyopechoic, usually well defined  triangle of breast tissue behind the nipple. The apex of the triangle abuts the posterior aspect of the areola.
In the minority of cases gynecomastia is bilateral. In bilateral cases ultrasound imaging may suffice without mammography.

Inheritance

The genetic predisposition for carcinoma breast can be inherited from both mother and father. First line family history includes both genders.
Due to the absence of lobules in the breast breast, the following conditions are extremely uncommon.