Breast Cancer Surgery for Men

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Although men make up less than 1% of cases of breast cancer, the disease is as serious for men as it is for women. Surgery is the treatment of choice for early-stage breast cancer for both men and women, but there are some differences in the type of surgery preferred, the option for reconstruction, and therapies that may be recommended in addition to surgery (adjuvant therapy) such as chemotherapy, radiation, and hormonal therapy.

Surgery

The treatments available for breast cancer are essentially the same for men as for women, including surgery.A primary difference, however, is for men, lumpectomy is less often an option. There is typically far less tissue in a man’s breast than a woman’s breast, which means a tumor of the same size spreads through a greater percentage of the breast in a man than in a woman, making complete removal of the breast, a mastectomy, a better option in some cases.

Adjuvant Therapy

After surgery for male breast cancer, chemotherapy and/or radiation may be recommended. Adjuvant therapy such as this is designed to "clean up" any remaining cancer cells that have spread beyond the breast, but are still too small to be detected on imaging tests.

Adjuvant therapy typically is advisable when a cancer has a significant risk of recurring. To determine this risk, doctors look at several factors including the size of the original tumor, the presence of involved lymph nodes, the tumor grade (which indicates the aggressiveness of the cancer), and genomic testing of the tumor (Oncotype DX).

Hormonal Therapy

Whatever primary treatment is used, hormonal therapy typically follows for most people who have estrogen receptor-positive tumors. Since 99% of breast cancers in men are estrogen receptor-positive, this means the vast majority of men will undergo hormonal therapy as part of treatment for breast cancer.

The preferred treatment for men is tamoxifen, although for those who do not tolerate tamoxifen or cannot take the medication for some reason, alternatives are available. Tamoxifen is usually continued for 5 years, with the option of continuing for an additional 5 years for those who have a high risk of recurrence.

Reconstruction

Reconstruction of the breast or breasts is a matter of personal preference and involvement of a plastic surgeon early in the surgery planning is important.

The choice to have reconstruction should be made with the decision to have the mastectomy when possible as immediate reconstruction, or reconstruction during the same surgery as the mastectomy, is possible.

Delayed reconstruction, or reconstruction of the breast after the day of the mastectomy, is also an option. However, some men will require an implant to make the breast size the same as the remaining breast and immediate reconstruction is recommended if an implant is required. This is because the combination of radiation and any skin stretching necessary to insert the implant can damage the skin and decrease the cosmetic appeal of the results.

Follow-Up and Recurrence

For men who've had breast cancer, yearly mammograms are recommended on the side where the cancer was diagnosed. Although screening of the uninvolved breast is recommended for women, it is not for men unless a genetic predisposition to the cancer (such as a BRCA mutation) has been identified.

Many people regard surviving for 5 years after breast cancer treatment as cured. However, this is not true for tumors that are estrogen receptor-positive. While men have not been studied, women with estrogen receptor positive breast cancers continue to have a steady rate of recurrence for at least 20 years, and recurrences after 5 years (late recurrences) are more common than in the first five years. This is the reason why hormonal therapy may be continued beyond 5 years. Recurrences in men have been documented up to 15 years after surgery and beyond.

Men who have had breast cancer surgery should visit their doctor if they have any symptoms suggestive of breast cancer recurrence such as a new lump, shortness of breath, chest pain, abdominal pain, or a persistent headache.

Breast Cancer, Males and Embarrassment

Many male breast cancer patients have an element of embarrassment regarding the diagnosis of breast cancer. There is a perception that it is a woman’s disease, and therefore men feel shame with the diagnosis. There is no reason to feel ashamed about the diagnosis of cancer of any type, a cancer survivor is exactly that, a survivor. The location of the tumor should not cause shame.

Because breast cancer in males is rare, it may be difficult to find a support group outside of large cities. For men outside of major cities, online support groups can be a fantastic resource.

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