Breast Cancer in Men: What You Need to Know

We never think of breast cancer as a disease that affects men; however, because men have breast tissue, they too can develop breast cancer, even though it's relatively rare. Male patients make up about 1 percent of all breast cancer cases in the U.S.  While that may sound like an insignificant amount, it actually represents over 2,000 expected new cases of male breast cancer yearly. Additionally, breast cancer kills about 400 men each year in the U.S.

The American Cancer Society estimates that about 2,620 new cases of invasive breast cancer will be diagnosed in men by the end of 2020, and some 520 men may die from breast cancer. The risk of developing male breast cancer during your lifetime is about 1 in every 833 men.

It has also been noted that the likelihood of developing breast cancer in men is highest among those that have a BRCA mutation. Genetic testing can help men become aware of whether or not they have this mutation and increased risk. Genetic counseling is also recommended for men diagnosed with breast cancer.

Fortunately, for men who have undergone a mastectomy or lumpectomy to treat breast cancer, breast reconstruction is an option.

Male Mastectomy

Because breast cancer in men is often more advanced than in female patients, due largely in part to the lack of awareness surrounding breast cancer in men, treatment often requires surgery and radiation treatments. In many men, treatment for breast cancer often involves a modified radical mastectomy. This procedure includes the removal of breast tissue, axillary lymph nodes, and often the nipple-areola as well, as this area is generally affected in most cases. In some cases, patients with male breast cancer may be candidates for nipple-sparing mastectomy or conservation of breast tissue by means of a lumpectomy and radiation treatment instead of a radical mastectomy, depending on the gravity and size of the malignancy.

Male Chest or Breast Reconstruction

Like women, following a mastectomy, men may have concerns about their physical appearance. A mastectomy may produce deformities of the chest wall and concerns about the appearance of the chest and breasts. Fortunately, while it is not widely talked about and there is still relatively little information available on the subject, male breast reconstruction is an option for most men and some health insurance carriers may even cover the procedure. Federal laws require that health plans that cover mastectomy must also cover breast reconstruction in both male and female patients.

Men who desire chest or breast reconstruction have several options to choose from to restore the natural appearance of their pectoral region. Depending on your condition, concerns, and aesthetic goals, a doctor may recommend fat grafting, breast implants, a “flap” reconstruction that uses tissue harvested from other parts of the body, reconstruction of the nipple and areola, and tattooing to make the reconstruction look totally natural. Breast reconstruction in men is typically performed after all cancer treatments have been completed.

Fat Grafting

Fat grafting or fat transfer is the most common type of reconstruction typically performed on male breast cancer patients.  This procedure uses liposuction to harvest fat from one area of the body, liquefy it, and inject it into the desired area in the breast. In many cases, as much as 30-50% of the injected fat may be reabsorbed by the body, so the fat grafting procedure may need to be repeated several times to obtain optimal results.

Implants

Chest implants, also known as pectoral implants, typically consist of low-profile custom-made silicone breast implants, may be positioned behind the chest muscle and used to reconstruct a contoured male breast.  This option is best for men who have lost substantial breast tissue and want to regain muscular definition in the pectoral region.

Flap Reconstruction

In some cases, patients may experience pectoralis, or advanced disease in the chest muscle itself, which typically requires a more comprehensive mastectomy in which muscle tissue is also removed along with the breast tissue and nipple. For these patients, a flap reconstruction may be the best option, using tissue from another area of the body, such as the back, to reconstruct the lost muscle and breast tissue.

Nipple Reconstruction

Nipple reconstruction may be performed as part of the breast reconstruction or as a separate procedure. There are several approaches to reconstructing the nipple and areola, but it is a simple procedure that produces a more natural-looking reconstruction.

When performed as a stand-alone procedure, nipple reconstruction is usually completed as an outpatient treatment in the comfort of the doctor’s office using local anesthesia. To finalize the reconstruction process, the nipple and areola are defined and reconstructed using cosmetic tattooing to achieve a totally natural-looking appearance as closely resembling the patient’s own natural nipples as possible. You may choose from various forms of cosmetic tattooing, and this may be performed at the time of the reconstruction or later as a separate stand-alone procedure. 3D tattooing achieves the most natural-looking results and is recommended in most cases. 

Scar Revision

Scar revision is another part of the reconstruction procedure that can greatly improve the appearance of a man’s chest following breast surgery. Scars following a mastectomy or lumpectomy may be visually jarring and detract from the overall appearance of the chest. In some cases, severe scarring may cause physical discomfort or scars may become tethered to the chest wall. Scar revision reduces the visibility and prominence of scar tissue to create a more attractive, streamlined, and contoured appearance.  Scar revision surgery may also be combined with fat grafting to improve the overall chest contour.

Expected Outcomes

Most reconstruction procedures provide long-term, and in many cases, permanent results.