Breast Cancer Surgery for Men

Males make up less than 1% of cases of breast cancer, and the disease is as serious for males as it is for females. Surgery is the treatment of choice for early-stage breast cancer for both males and females, and there are some differences in the type of surgery, the options for reconstruction, and adjuvant therapies (treatments used in addition to surgery), such as chemotherapy, radiation, and hormonal therapy.

Surgery

Lumpectomy, which can be an option for some females who have breast cancer, is not a usual option for males.

There is typically far less tissue in a male’s breast than a female’s breast, which means that a tumor of the same size spreads through more of the breast in a male than in a female. This makes a mastectomy (complete removal of the breast), a better option in some cases.

Adjuvant Therapy

After surgery for male breast cancer, chemotherapy and/or radiation may be recommended. Adjuvant therapy is designed to kill 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 cancer has a significant risk of recurring.

To determine this risk of recurrence, doctors consider several factors, including the size of the original tumor, whether lymph nodes are involved, the tumor grade (which indicates cancer aggressiveness), and genomic testing of the tumor.

Hormonal Therapy

For most people who have estrogen-receptor-positive tumors, hormonal therapy typically follows the primary treatment, And 99% of breast cancers in males are estrogen receptor-positive, so the vast majority of males will have hormonal therapy as part of treatment for breast cancer.

The preferred hormonal treatment for males is tamoxifen, and alternatives are available for those who do not tolerate tamoxifen or cannot take the medication for any reason. 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. If you will want to have a reconstruction, getting a consultation from a plastic surgeon early in the mastectomy surgery planning phase is important.

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.

Some males will need an implant to make the breast size the same as the other breast. Often, immediate reconstruction is often recommended if an implant is required because the skin can become damaged and difficult to stretch over an implant after radiation treatment.

Follow-Up and Recurrence

For males 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 females, it is not recommended for males unless a genetic predisposition to 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. This is the reason why hormonal therapy may be continued beyond 5 years.

Females 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. Recurrences in males have been documented up to 15 years after surgery and beyond.

Males who have had breast cancer surgery should visit their doctor to discuss any signs or symptoms that could indicate a breast cancer recurrence or metastasis (spread to other areas of the body), such as a new lump, shortness of breath, chest pain, abdominal pain, or a persistent headache.

Breast Cancer, Males and Embarrassment

Some male breast cancer patients may experience embarrassment regarding the diagnosis of breast cancer. There is a perception that it is a female disease, which can make the diagnosis confusing for some males. There is no reason to feel self-conscious about the diagnosis of cancer of any type. A cancer survivor is exactly that—a survivor—regardless of the location of the tumor.

Because breast cancer in males is rare, it may be difficult to find a support group outside of large cities. For males who don't have access to a local support group, online support groups can be a helpful resource.