Women are about 100 times more likely to develop breast cancer as men.
The estimated lifetime risk (to age 80) is less than 1% for men, compared to about 12% for women. (The risk is greater for men who have a BRCA gene mutation: 2% with BRCA1, 8.4% with BRCA2.) Nevertheless, male breast cancer does occur. It’s more common in men over the age of 60, although males of any age can be diagnosed.
Because men have far less breast tissue than women, a man’s tumor tends to spread through a greater portion of the breast than the same size tumor in a woman. And that means that lumpectomy usually isn’t an option. Treatment for male breast cancer usually requires mastectomy. The nipple, areola and breast tissue, which lies almost completely beneath the nipple, is removed (a total mastectomy). Some underarm (axillary) lymph nodes may also be removed (a modified radical mastectomy) and tested to determine whether cancer has spread beyond the breast. Treatment may also include radiation therapy and chemotherapy, depending on the nature of the tumor.
Like mastectomy in women, the surgery leaves a diagonal or horizontal scar across the chest. Men don’t typically need reconstruction after mastectomy, because the amount of tissue removed isn’t usually enough to disfigure the breast. A small flap reconstruction is possible, particularly when removal of a tumor in the chest wall leaves a concave chest. Nipple reconstruction, if desired, is also an option. Some men find that having a tattoo that simulates the nipple and areola makes them feel visually more balanced when they’re shirtless.
Men interested in reconstruction should speak with a board-certified plastic surgeon who specializes in male breast reconstruction, if possible. Breast reconstruction in men is rare, however, so this might be difficult. In any case, it’s a good idea to find a surgeon who is experienced with breast reconstruction. It’s best to consult with a plastic surgeon before mastectomy, so that immediate reconstruction is an option, unless some other health issue precludes that. In that case, delayed reconstruction (at some time other than the mastectomy) is also an option.
A local or online men’s cancer group can address these concerns and help patients deal with diagnosis and treatment.