Causes of Male Breast Pain and Swelling

Gynecomastia, Breast Cancer, and Other Male Breast Concerns

While we usually think of women when we talk of breasts, men have breasts, too. And like women, they at times have to cope with breast pain, breast enlargement, nipple pain, and even breast cancer.

Unfortunately, in our breast-fixated society, it can be embarrassing for a man to bring up concerns he has about his breasts. And, most of the time, men don't sip a cup of tea and talk to other men about their breast pain.

Let's take a close look at some of the potential causes of breast pain or swelling in men, including when men may need to be concerned about male breast cancer.

causes of male breast pain and swelling
Illustration by Emily Roberts, Verywell

Male Breast Development

Before puberty begins and hormone levels shift and rise, female and male breasts look very much alike. Children's breasts in both genders are primarily skin, fat, and connective tissue supporting a nipple and areola.

In the early teen years, the gender-specific hormones begin to transform our bodies for adulthood. In men, testosterone encourages testicular growth and usually prevents breast development. In women, estrogen signals developing milk-producing glands and increases breast size. Pregnancy completes female breast development.

Causes of Breast Swelling

Men often experience breast growth during adolescence. This is a normal process caused by hormonal changes and can produce breast swelling and tenderness, but probably won't cause breast pain.

This abnormal growth in breast tissue—known by the medical term gynecomastia—often occurs in men over the age of 50 due to slowdown in the production of testosterone.

Age is not the only thing that can influence breast growth. Gynecomastia is caused by any condition that can alter the production of hormones involved in breast physiology, either by stimulating estrogen or inhibiting testosterone. Even young boys and teens can develop gynecomastia.

In addition to being a process linked to aging, gynecomastia can also occur as a result of:

  • Liver disease
  • Alcohol abuse
  • Kidney disease (chronic renal failure)
  • Diseases of the testes
  • Testicle trauma (including testicular torsion)
  • Obesity
  • Hemochromatosis (iron overload)
  • Klinefelter syndrome
  • HIV infection
  • Hyperparathyroidism
  • Hyperthyroidism
  • Adrenal diseases, such as Addison's disease or Cushings disease
  • Malnutrition
  • Cancers such as lung cancer, liver cancer, adrenal gland cancer, or breast cancer
  • Extreme stress (due to increased estrogen levels)
  • Heroin or marijuana abuse
  • Idiopathic (a term used when no apparent cause can be found)

Certain drugs can also cause gynecomastia, including amiodarone, amphetamines, calcium channel blockers, cimetidine, diazepam, isoniazid, ketoconazole, marijuana, methotrexate, spironolactone, and tricyclic antidepressants. Long-term use or overuse of these medications can increase the risk, especially in older men.

Often times, more than one factor is involved in gynecomastia that has become bothersome. For example, a man have mild gynecomastia due to age or obesity which becomes more pronounced (and annoying) after starting one of the medications known to cause gynecomastia.

Cause of Breast Pain

Most causes of male breast pain are relatively benign. A few of the more common causes of male breast pain include:

  • Breast injury: An injury to the breast (from sports, motor accidents, etc.) can sometimes cause the death of fatty tissue (breast fat necrosis), cause a lump or dimpling of the breast that is similar in appearance to breast cancer. Unfortunately, breast fat necrosis can look very similar to breast cancer on a mammogram, and sometimes a needle biopsy is needed to confirm necrosis instead of cancer.
  • Runner's nipple: It's not uncommon for men to develop irritated or bloody nipples from jogging, hence the names "runner's nipple" or "marathoner's nipple." Just as friction over other areas of the body can cause discomfort, friction over the nipples can result in pain and bleeding.
  • Mastitis: An infection of breast tissue called mastitis can occur in men as well as women.
  • Breast cyst: A breast cyst is a fluid-filled sac in the breast and may occur in men as well as women. 
  • Fibroadenoma: While uncommon in men, a benign breast tumor composed of glandular and fibrous breast tissue known as a fibroadenoma may occur.

Male Breast Cancer

Breast cancer in men is certainly much less common than in women—there are 100 cases diagnosed in white women for every case diagnosed in white men —but considering how common breast cancer is in women, male breast cancer does occur.

Male breast cancer is a rare disease, accounting for between only 0.5 % and 1% of all breast cancer cases. Still, around 2,000 men are diagnosed with breast cancer in the United States each year, with most occurring in men over 60. Common risk factors include a family history of breast cancer, obesity, Klinefelter syndrome, and radiation exposure.

Symptoms of breast cancer in men are similar to those in women:

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

Most men with breast cancer do not usually experience any pain, but this should not lead you to assume that a breast lump is not cancer if it is accompanied by pain.

Breast cancer may also present with symptoms due to the spread of the cancer (metastatic breast cancer) to other regions of the body. This may include pain or a fracture (due to bone metastases), abdominal pain or jaundice (due to liver metastases), headaches, one sided weakness, or speech difficulties (due to spread to the brain), or a cough and shortness of breath (when a cancer spreads to the lungs).

For men with a family history of breast cancer, doing a male breast self-exam (MBSE) is an easy way to be aware of any changes in your breasts.

Men and women who carry the mutated BRCA1 or BRCA2 gene are at increased risk of developing breast cancer. There are also non-BRCA gene mutations associated with breast cancer, and some of these increase the risk of breast cancer in men. It's important to know your family history of cancer so you can be proactive about screening for these mutations.

It's also important to keep in mind that a family history of other types of cancer can be equally important. For example, BRCA2 mutations increase not only breast cancer risk, but that of prostate cancer (significantly) and pancreatic cancer. If you have a strong family history of cancer, it's important to see a genetic counselor. Gene testing for cancer predisposition is still young, and a good genetic counselor may be able to determine if you are at risk even if your testing is negative.

A Word From Verywell

A very important point to consider for men experiencing breast pain—especially men over 50—is whether the pain is originating in your breast or could be coming from somewhere else.

If you have breast pain, start by examining the painful area and try to determine what is causing the pain. If there is a breast lump of any sort, do not hesitate to see a doctor. Even though breast cancer is rare in men, it can occur. By diagnosing and treating cancer early, you will almost invariably have better outcomes.

Frequently Asked Questions

  • What are the main differences between gynecomastia and male breast cancer?

    Clinicians use several criteria to help distinguish male breast cancer from gynecomastia, including:

    • Swelling or enlargement affects both breasts equally in gynecomastia, while only one breast is affected by cancer.
    • With gynecomastia, breast tissue feels smooth and firm and moves easily; with breast cancer, it may feel rubbery or hard and fixed in place.
    • Breast skin affected by cancer may be thick or red or even have sores, but looks normal in gynecomastia.
    • Nipples are normal with gynecomastia, but may be deformed or leak fluid with breast cancer.
  • How common is breast cancer in men?

    The incidence of male breast cancer is extremely low, especially when compared to that of women. In 2021, it was estimated there would be 2650 new cases of male breast cancer, while as many as 330,840 women would be diagnosed with breast cancer (invasive and in situ types combined).

  • Is male breast cancer life-threatening?

    It can be. The estimated five-year survival rates for men with breast cancer are based on the stage of disease at the time it's diagnosed:

    • Localized: 97%
    • Regional: 84%
    • Distant: 22%
    • All stages combined: 84%

    Keep in mind many other factors, including advances in treatment, will play a role in an individual's prognosis.

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