Gynecomastia of the mammary glands. Mammography for diseases of the male breast Mammography for men

website - 2007

Tumor of the breast in men occurs 100 times less frequently than in women. Thus, we can say that less than 1% of all cases of breast cancer occur in men.

After the doctor or the patient himself has discovered a tumor or some other neoplasm in the chest area, certain research methods are carried out to clarify the diagnosis.

  • Mammography. Mammography is an x-ray method for examining the mammary glands. For this, two x-rays are taken - front and side. After that, a specialist radiologist examines the obtained images. If on the basis of the obtained images there is a suspicion of a pathology, then additional images of a certain area of ​​\u200b\u200bthe chest are taken - these are the so-called sighting images.
  • Ultrasound procedure. This research method has gained well-deserved popularity among doctors and patients due to its low cost, simplicity and safety for the patient. The principle of this method is that based on the different passage of ultrasound through certain tissues, a picture is created in the computer. Judging by it, the doctor assesses the condition of tissues and organs. If a tumor-like mass is found on mammography or during manual examination, then ultrasound can determine whether the tumor is a “solid” mass (for example, cancer or fibroadenoma) or a hollow one with fluid content (cyst). Unfortunately, ultrasound does not allow to determine the benign or malignant nature of the tumor.
  • Examination of discharge from the nipple. If there is discharge from the nipple, it must be sent for cytological examination to identify possible cancer cells.
  • Biopsy. A biopsy is a study of a piece of tissue taken from a tumor to determine its structure. Only a biopsy can reliably establish the diagnosis of cancer. A biopsy is performed for any pathological changes in the breast. There are several biopsy techniques, each of which is indicated in certain cases. a biopsy is an invasive research method, that is, it requires the use of tools that violate the integrity of the skin.
  • Needle biopsy. This study is carried out using a needle and syringe. The needle is inserted into the tumor and its tissue is, as it were, “pumped out” with a syringe. Next, the resulting tissue is examined for the presence of cancerous (atypical) cells. Sometimes the tumor is not palpable, then an ultrasound or x-ray is used to conduct a needle biopsy, which helps guide the needle into the thickness of the tumor.
  • Stereotactic needle biopsy. In this case, several tissue samples are taken from the tumor. As mentioned, if the tumor is not palpable, ultrasound or mammography comes to the rescue.
  • incisional biopsy. This method is more like surgery. In this case, a larger area of ​​tissue is taken than with a conventional needle biopsy. Often, an incisional biopsy is performed when a needle biopsy is not very informative or when the tumor is too large. The purpose of this procedure is to make a diagnosis. Since only part of the tumor is excised. This procedure is not in any way medical. Usually, if a man has breast cancer, it is completely removed.
  • Excisional biopsy. This biopsy method consists in the complete excision of the tumor from the breast. This is the most accurate method for diagnosing cancer. Both methods of biopsy: incisional and excisional - can be performed on an outpatient basis, under local anesthesia. The purpose of these methods, as indicated, is the diagnosis of cancer. Even if the entire tumor was removed during the biopsy, this does not mean at all that the patient is cured, since in any case a mastectomy is required.
  • Removal of lymph nodes for breast tumors in men
  • Diagnosis of a breast tumor in men

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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

Even men may really need a mammologist, and this can happen with almost every member of the stronger sex.
In what cases can men need such a doctor?
There are few such cases, more precisely, it is only one. A man may need this specialist only if he develops a disease such as gynecomastia.

What is this ailment?
Gynecomastia is an enlargement of the mammary glands or glands in men. This condition occurs as a result of the growth of breast tissue. This is true gynecomastia. If we talk about false gynecomastia, then this pathology occurs due to excessive deposition of fatty tissues that appear as a result of a disease such as obesity. In addition to breast augmentation, a man can also experience pain in this area. These pain sensations occur against the background of the growth of glandular tissue. It should also be noted that these pain sensations can both suddenly appear and suddenly disappear.

What are the causes of gynecomastia in men?
The most common cause is considered to be the predominance of female sex hormones in the male body. There is another reason - a decrease in the amount of male sex hormones. In principle, this disease is curable. In the fight against it, the patient is assigned anabolic steroid. The most important thing is that the treatment of this disease should be started in a timely manner. Prolonged lack of treatment for gynecomastia is a direct path to the development of breast cancer.

Before use, you should consult with a specialist.
Read more:
  • Mammologist - what does he treat? Who is an oncologist-mammologist, surgeon-mammologist, gynecologist-mammologist? Where does he receive (hospital, clinic)? How do I book an appointment with a doctor for a breast exam? How to get advice?

Various diseases of the male breast have characteristic mammographic features that correlate with pathomorphological characteristics. Breast cancer in men is usually subareolar and eccentric to the nipple. Compared with breast cancer in women, breast cancer in men has the features that its boundaries are more often well defined, calcifications are less common. Gynecomastia is more often manifested by a fan-shaped spreading seal emanating from the nipple and gradually dissolving in the surrounding fatty tissue. With gynecomastia, there may be processes in the surrounding fatty tissue, and in some cases have a heterogeneous density resembling the female mammary gland. Although breast cancer in men has regular mammographic features, there are certain differential diagnostic problems with other nodular pathologies. The mammographic features of gynecomastia quite clearly distinguish it from cancer, but in rare cases, gynecomastia can closely resemble cancer. In some cases, chronic inflammation can be mistaken for gynecomastia. All mammographically transparent male breast masses are benign, as are the corresponding female breast masses.

Mammography for gynecomastia

Gynecomastia is quite common. According to Nutall, up to 57% of men over 44 years of age have palpable breast tissue. Gynecomastia is characterized by hyperplasia of the ductal (ductal) and stromal elements of the male breast. Clinically, gynecomastia appears as a soft, mobile, tender mass in the retroareolar space. The presence of gynecomastia is often combined with elevated serum levels of estradiol and a decrease in testosterone levels. This increased estradiol-testosterone ratio may arise from physiological changes during puberty and aging, but may also be due to endocrine pathology, the use of hormonal drugs, systemic diseases, tumors and certain drugs. Three mammographic types of gynecomastia have been described:

    nodular (nodular),

    dendritic (fibrous)

    diffuse type.

Nodular (nodular) mammographic type of gynecomastia

Has the appearance of a fan-shaped seal extending from the nipple, may be symmetrical, or more pronounced in the outer quadrant. The induration usually merges with the surrounding fat, but may be more spherical. The nodular type correlates with the pathological classification of florid (active) gynecomastia, which is considered an early phase of gynecomastia. Histological examination of this type of gynecomastia is characterized by hypoplasia of the intraductal epithelium, with a few cellular stroma and surrounding edema.


Dendritic mammographic type of gynecomastia

The dendritic type of gynecomastia manifests itself as a retroareolar soft tissue formation, with radial outgrowths extending deep into the adipose tissue. The dendritic type correlates pathologically with the fibrous form of gynecomastia, which is considered to correspond to the long-term existence of gynecomastia. The histological characteristic of fibrous gynecomastia is ductal proliferation with dense fibrous stroma.

Diffuse mammographic type of gynecomastia

With a diffuse (glandular) type of gynecomastia, there are mammographic signs similar to the appearance of a heterogeneously dense female mammary gland

The above mammographic types of gynecomastia allow us to describe the vast majority of cases. Less common are small forms of gynecomastia, which, on the basis of mammography, are difficult to attribute to any group.

What a man needs to know about the female and male breasts.

How is the structure of the male breast different from the female?

Practically nothing, except for the size and degree of development of the glandular tissue.

Why do men need them?

For nothing!

How to take care of them?

Conduct regular self-examination for the presence of seals and discharge from the nipples, avoid injury, and maintain hygiene.

What to look for and what diseases of the breast can men have?

You need to pay attention to the change in size (an increase in one or both glands), a change in color (redness), the presence of seals in the glands or in the projection of the axillary lymph nodes, the presence of discharge from the nipples (bloody discharge is especially dangerous), the appearance of sores on the nipple or near it.

Does male breast cancer happen?

It happens. Breast cancer in men is 100 times less common than in women.

Men, as a rule, pay attention to changes in the mammary glands late and seek help from a doctor with already running processes in the glands.

Since the size of the mammary glands in men is small, the tumor grows rapidly and penetrates beyond the organ.

Who can get this terrible disease?

The disease can occur in any man, but men should especially monitor their health if their relatives had breast cancer in their family, regardless of men or women.

The genetic factor is incredibly important.

The risk group includes people who have diseases of the endocrine system, including diabetes, thyroid disease, and others. Long-term use of hormonal drugs can serve as a risk factor. Breast injury must be avoided.

Bad habits remain relevant: everything to which the word abuse can be applied. Athletes who take anabolic steroids have an increased risk of developing breast cancer and other diseases.

What to do if, during lovemaking, a man finds a seal in the chest of his beloved? Believe me, this happens often.

First, there is no need to panic, because not every formation in the mammary gland is cancer.


-This may be a manifestation of cystic fibrous mastopathy
-it could be a cyst
-it could be a benign tumor, etc.

Undoubtedly, one thing: you need to reassure the woman and gently insist on an immediate examination.

You need to contact a mammologist or oncologist, the doctor will conduct an examination and prescribe the necessary additional examinations that will clarify the nature of the formation in the mammary gland.

The most reliable diagnostic methods are mammography and ultrasound examination of the mammary glands.

If necessary, a targeted biopsy will be performed to clarify the structure of the formation.

Secondly, even malignant tumors detected at early stages, and with the right treatment started in a timely manner, they can be treated with very good results and maintaining the woman's health and quality of life. It is necessary to provide maximum moral support to the woman and steadfastly go through the entire path of treatment with her, constantly instilling in her confidence in a favorable outcome of treatment.

What are the risk factors for the development of malignant and other diseases of the mammary glands?

Genetic predisposition to tumors
- stress
- excess weight
- smoking
- alcohol abuse
- abortion, no pregnancy
- lack or irregular sex life
- injuries and inflammatory diseases of the mammary glands
- the presence of diseases of the endocrine system:
- thyroid gland, diabetes mellitus
- diseases of gynecological organs
- prolonged wearing of a synthetic and tight bra
- prolonged and frequent exposure to the sun or in a solarium

Who needs a mammogram and how often?

Be sure to undergo mammography for women who have close relatives: mother, grandmother, sisters, especially on the maternal side, had breast cancer.

Such women need to be examined starting from the age of 35 annually, and sometimes twice a year.

All other women over 35 - 40 years old are recommended to be examined 1-2 times a year for preventive purposes.

In all developed countries, all women over 35-40 years of age undergo this procedure at least once a year or every two years.

The procedure takes several minutes and allows you to detect the presence of a tumor with a size of several millimeters, when neither the woman herself nor the doctor can detect the tumor during examination due to its small size.

Breast cancer does not grow very fast, it will take more than a year, and sometimes several years, before it can be detected during self-examination or examination by a doctor.

Time will be lost and the result of treatment will be completely different. If a malignant tumor is detected at an early stage and treatment is started in a timely manner, a woman retains her ability to work and quality of life.

Why don't all women get mammograms?

There are many reasons. Some women do not have information, some women are limited in time, busy with family, children and other constant problems, but most women are simply afraid to go for an examination and find out the truth about themselves.

Husbands often bring their wives by the hand and ask them to be examined. Well done!

Sometimes in lectures I ask men: has their wife, (mother, sister, daughter) had a mammogram? Most common answer: no.

Let's take care of our health and that of our loved ones.

Can men get mammograms?

For diagnostic purposes, mammograms are often done for men, the study is carried out in the same way as for women.

This study allows you to quickly and correctly diagnose and begin the necessary treatment.

For preventive purposes, mammograms are rarely done in men.

Families are known where breast cancer in men occurs in every generation. Men in such families with a high risk of developing a tumor need regular supervision by an oncologist and, if necessary, additional examinations, including mammography and ultrasound examination of the mammary glands.

If a woman has mammary glands of different sizes?

Asymmetry of the mammary glands is quite common. This is not a disease, but it is necessary to monitor the mammary glands, to conduct a self-examination at least once a month.

If a woman (man) had the same size mammary glands and the size of one gland has changed (increased or decreased), you should immediately consult a doctor.

What can a man do for a woman's health?

Take care of the woman. Help her eliminate those risk factors that a woman can eliminate.

Quit smoking, normalize sleep, monitor your weight, sleep 8-9 hours, have sufficient physical activity, and one of the most important conditions is to eliminate stress. E

is that impossible? It is impossible to completely eliminate stress, but one must strive for this, and if the situation cannot be changed, then one must develop the right reaction to it.

Respect for a woman is also in the prevention of unwanted pregnancy. BUT

board causes great harm to both the physical and psychological health of a woman.

Where can you get tested?

We invite women who take care of their health and value their time to be examined in a modern medical institution - the Perinatal Medical Center, which is located in a convenient place in the city.

In our department, you can undergo a mammography examination using modern equipment, at any time convenient for you, as we work around the clock.

Women 40 years of age and older should be screened at least once every 2 years.

Patients at high risk (risk groups) should undergo the procedure from an earlier age once a year.

Mammography is performed from days 5 to 11 of the menstrual cycle, counting from day 1.

During menopause, the study is performed on any day. Special preparation is not required.

The pathology of the mammary glands in the form of fibrocystic transformation is called mastopathy. This disease is attributed to women, although men have similar conditions. In the representatives of the stronger sex, the mammary glands are more often affected in adolescence. But sometimes painful seals occur at a different age (including childhood and senility).

All benign diseases of the mammary glands in men, occurring with tissue hypertrophy, are called gynecomastia(see fig 1).

Rice. 1 - Hypertrophy of the mammary glands in men - gynecomastia (before and after surgery).

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The mammary (breast) glands are formed during fetal development in both boys and girls. Before puberty (puberty), there is practically no difference in the anatomical structure of this area. Then, in adolescent girls, glandular tissue grows under the influence of estrogens, gestagens, and prolactin. The volume, shape, structure of the organ changes. In young men, the mammary glands practically do not develop. In adulthood, males have an areola of relatively small diameter and a nipple 2-4 mm high. The mammary glands are located between the fourth and fifth ribs to the left and right of the midline. The tissue of the organ (when examining a macropreparation) has a whitish color. Slices and passages are poorly developed, short. The thickness of the mammary gland in a man is normally up to 5 mm, and the width is up to 15 mm.

In the histological structure, 2 departments are distinguished:

  • secretory (consists of epithelial ducts);
  • interstitial (consists of connective tissue).

A number of hormones affect the glandular tissue in men. The main role belongs to androgens, prolactin, estrogens, gonadotropins, growth hormone. At the same time, sex steroids have a greater effect on the epithelial ducts (parenchyma), and prolactin - on interstitial tissues.

What is gynecomastia?

Breast hypertrophy in men is called gynecomastia. The increase can be due to different tissues. If the volume grows due to subcutaneous fat, then gynecomastia is false. An increase in size due to glandular tissue is called the true form of this condition. Quite often, gynecomastia is considered mixed (both glandular and fatty components are present in the tissue (see Fig. 1)).

Rice. 2 - Gynecomastia caused by the growth of glandular tissue and subcutaneous fat (mixed gynecomastia).

False gynecomastia usually occurs with, and true and mixed are a manifestation of hormonal imbalance or a serious illness.

Stages of development of gynecomastia:

  • proliferation of the thoracic ducts;
  • growth of the glandular component;
  • fibrous growth (proliferation of connective tissue).

Gynecomastia is considered a variant of the norm:

  • in newborns (determined in 50% of boys);
  • in adolescents (detected in 40-60% of young men);
  • in the elderly (occurs in 25-30% of men over 50).

Breast enlargement in newborns is associated with maternal estrogen exposure. Gynecomastia usually goes away in the first month after the baby is born.

Hypertrophy of the glandular tissue in boys in puberty is associated with hormonal changes in the body. Breast augmentation resolves on its own in 6-24 months.

In older men, gynecomastia occurs due to a fall and the occurrence of a relative.

In adult young men without excess weight, gynecomastia is relatively rare (10-20%).

Table 1 - Degrees of hypertrophy of the mammary glands.

These grades are used to evaluate true and mixed gynecomastia.

Pathological causes of gynecomastia

Breast hypertrophy in men can occur due to physiological or pathological causes. The first group includes all natural etiological factors (aging, puberty, etc.).

Pathological causes include:

  • genetic diseases (Klinefelter's syndrome);
  • tumors with hormonal activity;
  • liver failure;
  • taking certain medicines;
  • starvation.

One in 500 newborn boys has an extra chromosome (47,XXY versus the usual 46,XY) in their cells. In such children, all the signs of Klinefelter's syndrome are further formed. They include characteristic appearance, hypogonadism, infertility, erectile dysfunction. Also, from adolescence, patients experience gynecomastia.

The most pronounced change in the hormonal background and the appearance of gynecomastia provoke neoplasms of the testicle, adrenal cortex, and pituitary gland. Such tumors can be a source of estrogens, gestagens, androgens. Prolactinoma of the pituitary gland is also relatively common. In this case, a benign neoplasm releases an excess level of prolactin into the blood.

Thyrotoxicosis is accompanied by gynecomastia in 20-40% of men. Excess leads to activation of the reticular zone of the adrenal cortex. Endocrine cells in this area produce androgens. But these sex steroids, due to thyrotoxicosis, quickly undergo transformation into. As a result, the relative predominance of female steroids is formed in the body.

Excessive aromatization of testosterone in peripheral tissues is also provoked by the metabolic syndrome (see Fig. 3). The pathology is based on insufficient tissue sensitivity to pancreatic insulin. This condition is also often accompanied by hypogonadism. Testosterone is secreted insufficiently, as the testicles can be damaged by hyperglycemia and hypercholesterolemia, characteristic of the metabolic syndrome.

Rice. 3 - The effect of increased aromatase activity on the level of androgens in men.

Starvation, stress, severe somatic diseases sometimes disrupt the hormonal balance of the male body. If there is a relatively large amount of estrogen, then gynecomastia naturally appears.

From drugs and narcotic substances, hypertrophy of the mammary glands is provoked by:

  • antiandrogens (flutamide, veroshpiron, finasteride);
  • androgens;
  • anabolic steroid;
  • antiretroviral agents (efavirenz and others);
  • sedatives (diazepam);
  • antidepressants;
  • antibiotics;
  • chemotherapeutic agents;
  • cardiac glycosides (digoxin);
  • antihypertensive (calcium channel blockers);
  • alcoholic drinks;
  • drugs (opiates, amphetamines, etc.).

It is known that biologically active food supplements, some products, and cosmetics can also increase the level of estrogen.


Rice. 4 - Enlargement of the mammary glands, provoked by the use of anabolic steroids.

Symptoms of breast pathology in men

Signs of gynecomastia can be mild or quite severe.

The main complaints in men associated with this disease:

  • swelling in the nipples;
  • pain in the nipples;
  • discomfort and a feeling of pressure in the projection of the pectoral muscles;
  • discharge from the nipples;
  • increased pigmentation of the areola;
  • an increase in the volume of soft tissues in the pectoral muscles.

When feeling the chest, men can independently detect a small rounded formation located behind the areola.

Also, the patient notes the accumulation and sagging of adipose tissue in the chest area. Outwardly, the male body begins to resemble the female (visible mammary glands are formed).

Usually, the changes are bilateral, that is, the right and left glands are hypertrophied. If the increase occurs only on one side (Fig. 5), then the risk of a malignant process is higher.

Rice. 5 - Uneven hypertrophy of the mammary glands may indicate a malignant process.

Examination for mastopathy in men

Boys and men with newly emerged gynecomastia must undergo a comprehensive examination. This condition is usually benign and harmless to health. In many cases, it does not require treatment. However, there are situations when breast hypertrophy occurs due to malignant neoplasms or other serious illnesses that require immediate medical attention.

Diagnosis can be carried out by a general practitioner, therapist, surgeon, endocrinologist, andrologist, oncologist, etc.

The standard examination includes:

  • collection of information (anamnesis);
  • inspection;
  • palpation (feeling);
  • ultrasound procedure;
  • hormonal profile;
  • blood chemistry;
  • mammography;
  • tomography;
  • puncture.

An integrated approach allows you to clarify the presence, nature and degree of gynecomastia, as well as its causes.

Treatment of mastopathy in men

Physiological gynecomastia usually resolves on its own and does not require special treatment. In adolescence, some patients require a consultation with a psychologist to adapt to the characteristics of growing up and changes in their own body.

If endocrine diseases (thyrotoxicosis, hyperprolactinemia) have led to breast hypertrophy, then the patient is recommended first of all to treat these pathologies.

If gynecomastia is due to hypogonadism, then the patient may be prescribed.

Surgical treatment is carried out:

  • with a pronounced cosmetic defect;
  • with fibrosis of the mammary glands;
  • with nodal forms of the disease;
  • with suspicion of oncological process.

The operation includes a mastectomy () and liposuction (removal of fatty tissue).

Endocrinologist Tsvetkova I. G.

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