Causes of Male Breast Pain and Swelling

Male breast pain is not often talked about. The same is true for nipple pain, changes in breast size, and breast cancer in men. As a result, many treatable breast conditions may be left undiagnosed until they have advanced.

This article explains the possible causes of breast pain and swelling in males. It also discusses when breast pain may be a sign of a more serious concern, like breast cancer.

Causes of Male Breast Pain

Most causes of male breast pain are benign, meaning not cancerous. Breast pain can be caused by hormonal changes, infections, injuries, or from unknown causes. 

Some common causes of male breast pain include:

• Nipple fissure: It's common for individuals to get irritated nipples from jogging or running, sometimes referred to as "runner's nipple." Friction over the nipples can result in pain, discomfort, and even bleeding.
• Breast injury: An injury to the breast may cause the death of fatty tissue. This can lead to a breast lump or dimple that can look like breast cancer, even on an imaging test. A biopsy, which uses a needle to draw out fluid from the lump, may be needed to rule out cancer.
  
• Mastitis: An infection of breast tissue can occur in males on rare occasions, though the cause is unknown.
• Fibroadenoma: While uncommon in males, this benign breast tumor can occur. Breast swelling usually occurs alongside fibroadenoma. The causes are unclear but may be due to a hormonal imbalance.
• Breast cyst: A breast cyst is a fluid-filled sac that's not cancerous. Extremely rare cases have been reported in males. The cause is not known.
  

Causes of Male Breast Swelling

Overdevelopment or swelling of breast tissue, also called gynecomastia, can occur because of a variety of health conditions and use of certain medications. Age can also be a factor.

Breast swelling can occur:

• During the teen years, as a normal part of the hormonal changes that occur during puberty
• Over the age of 50, as the body naturally starts to make less testosterone

Any condition that increases estrogen or decreases testosterone can cause gynecomastia. More than one factor may also be at play.

For example, someone may have mild gynecomastia because of their age, weight, and medications they take.

Keep in mind that the cause of breast swelling in some cases may be unknown.

Health Conditions

Other possible causes of gynecomastia include:

• Alcohol use disorder
• Addison's disease, in which the adrenal glands do not produce enough hormones
• Cancers of the lung, liver, adrenal glands, or breasts
• Chronic kidney disease
• Cushing's syndrome, caused by persistently high levels of cortisol
• Hemochromatosis (excessive levels of iron)
• Human immunodeficiency virus (HIV)
  
• Hyperparathyroidism, when the parathyroid glands produce too much hormone
• Hyperthyroidism, when the thyroid gland produces too much hormone
• Hypogonadism (low testosterone)
• Klinefelter's syndrome, a genetic condition in which a person born male has an extra X chromosome
• Liver damage
• Malnutrition
• Obesity
  
• Testicular trauma
  

Drugs

Certain drugs can also cause gynecomastia, including:

• Medications that regulate the heartbeat like Cordarone or Pacerone (amiodarone )
• Stimulants like Adderall (dextroamphetamine-amphetamine) and Vyvanse (lisdexamfetamine dimesylate)
• Drugs that treat heart conditions, including calcium channel blockers like Cardene (nicardipine)
• Ulcer medications like Tagamet (cimetidine)
• Valium (diazepam), a benzodiazepine used to treat anxiety and muscle spasms
• Antibiotics such as Hydra (isoniazid)
• Antifungal medications like Nizoral (ketoconazole)
• Rheumatrex (methotrexate), a drug that is used to treat cancer, rheumatoid arthritis, and other conditions
• Aldactone (spironolactone), a diuretic or water pill used to treat a variety of conditions
• Tricyclic antidepressants, which are used to treat depression and other conditions, like Elavil (amitriptyline)
• Recreations drugs like heroin and cannabis

Long-term use or overuse of these medications can increase the risk of breast swelling, especially in older males.

Breast Cancer in Males

Generally, male breast cancer is rare, but it does happen. In 2021, there were about 2,650 new cases of breast cancer in males compared to 281,550 new cases in females. Most cases involve males over the age of 60.

Male breast cancer does not affect all groups equally. Black males have the highest incidence of breast cancer incidence overall, while Latinx males have the lowest.

Black males also have the highest rate of mortality (death) from breast cancer when compared to White and Latinx males.

Risk Factors

Common risk factors for male breast cancer include:

• Family history of breast cancer
• Obesity
• Klinefelter's syndrome
• Radiation exposure

Males who have a mutated BRCA1 or BRCA2 gene have a higher risk of breast cancer than males who do not.

There are also non-BRCA gene mutations associated with breast cancer. Some of these increase the risk of breast cancer in males. Knowing your family history of cancer is important, as it can prompt you to be proactive and get screened for these mutations.

Remember that a family history of other types of cancer is also important in understanding your cancer risk. For example, BRCA2 mutations increase the risk of breast, prostate, and pancreatic cancer.

Symptoms of Male Breast Cancer

Symptoms of breast cancer in males and females are similar and include:

• A lump or swelling of the breast 
• Breast skin dimples or puckers that don't go away
• Red, scaly skin on the breast, areola, or nipple
• Nipple retraction 
• Nipple discharge
• Swollen lymph nodes, or glands, in the armpit

If breast cancer spreads to other areas of the body, it can cause additional symptoms, sometimes far away from the original cancer location. Cancer that has spread is called metastatic cancer.

Symptoms of metastatic cancer can include:

• Pain or a fracture due to bone metastases
• Jaundice, a yellowing of the skin and whites of the eyes (due to liver metastases)
• Headaches, one-sided weakness, or speech problems due to cancer spreading to the brain
• Cough and shortness of breath if cancer spreads to the lungs

Diagnosis

Individuals with a family history of breast cancer can do a breast self-exam. This is an easy way to be aware of any breast changes.

If cancer is suspected, your healthcare provider will start by reviewing your medical history and conducting a physical exam to check for the consistency and characteristics of the lump and to check if there are any enlarged lymph nodes nearby.

Other tests may be ordered, including:

• Mammogram (a low-energy X-ray test used to screen for breast cancer)
• Breast ultrasound (a non-invasive test that can differentiate cysts from tumors)
• Genetic testing (to check for gene mutations associated with breast cancer)
• Breast biopsy (used to obtain a tissue sample of the tumor for the lab)

Summary

Males may experience breast pain and swelling. In many cases, the cause is not of major concern. However, breast pain and swelling may be symptoms of something more serious. You may have an injury, infection, or an underlying medical condition—including cancer.

Be sure to let your healthcare provider know if you have any breast pain and swelling, or notice any other breast changes.