Dear Dr. G,

I am a man in my sixties and I started having strange sensations in my chest about a year ago.

It started off as a tingling sensation in my nipples, followed by a nagging discomfort in both my breasts.

Apart from the “man boobs” I have, there is no lump that I can feel on my breasts.

My wife thinks it was all in my mind but I was bothered enough to consult a breast specialist.

The doctor told me I have mastalgia, which could be due to hormonal changes.

I was assured that this was not serious, but was told more tests would be needed if the pain persisted.

In the spirit of Pink October, I would like to put Dr G on the spot for some clarification on what mastalgia is.

What causes breast pain in men? What do I look out for? Is there any treatment available?

Please help me to get this mystery pain off my chest.


Breast Pain Brad

Both men and women are born with breast tissues and mammary glands. The development of these glands becomes active in girls after puberty but in boys, this does not progress despite hormonal surges.

Although male breasts are effectively functionless, men are still at risk for conditions that affect breast tissue.

The word mastalgia is derived from “mast”, meaning breast, and “algia”, denoting some kind of pain. This can range from mild tenderness to stabbing pain in the chest.

In women, some pain involving one or both breasts can repeatedly occur before menstruation. Apart from this, breast pain in women is related to oral contraceptive pills, early pregnancy and the onset of menopause. Only about 2% of breast pain is related to breast cancer.

In men, common conditions that can cause breast pain are breast fat necrosis and trauma. Breast necrosis is rare in men but when breast tissue is badly damaged (in a car accident, for example), the tissue can undergo cell death and regeneration. This process can cause lumps to form. The skin around the lump may appear red or bruised and can also be dimpled, which mimics cancer. Occasionally, an ultrasound and a biopsy of the lump may be necessary to confirm the diagnosis. Fat necrosis of the breasts is usually self-limiting as the dead tissue will dissolve over time but in severe cases, surgical removal may be needed.

Muscular strain after exertion or heavy lifting is another common cause of breast pain in men. Although the pain may not originate from the breast tissue itself, pain in the muscles and tendons may make it appear so. Rest and stretching exercises are usually required to facilitate healing and pain relief in this case.

However, gtynecomastia and breast cancer can be a cause of concern for men who experience mastalgia. Gynecomastia is the benign overgrowth of breast tissues in men, caused by the imbalance of male and female hormones. The condition is usually painless, but many men would feel self-conscious of their moobs after encountering breast discomfort.

This overgrown tissue, however, could have an underlying lump which may mark the onset of breast cancer. Breast cancer in men is rare, but usually present as a lump with skin puckering and dimpling, which requires urgent surgical removal. Although gynecomastia itself is benign, some men with constant discomfort may opt for medical treatment such as tamoxifen, radiation or even surgery like liposuction and mastectomy.

Other breast conditions that may cause mastalgia include cysts and fibroadenoma. Breast cysts are common in women but rare in men. Fibroadenoma is a non-cancerous lump in the fibro-glandular tissue. Both these lumps may or may not be palpable externally, but a common symptom is breast discomfort.

Non-breast causes of chest pain may also be a common cause of mastalgia, as the location of the pain may be vague and difficult to pinpoint. Discomfort in the chest is commonly associated with heartburn, respiratory and heart diseases. Therefore, persistent breast pain of unknown origin may warrant endoscopic, X-rays imaging or ECG to delineate other non-breast related conditions that can mimic mastalgia.

In the spirit of Pink October, it is important to be breast cancer-aware, but also to demonstrate empathy. The famous multiple Oscar-winning actress, Meryl Streep once said: “The great gift of human beings is that we all have the power of empathy”.

Dr G assures men with mastalgia that the condition is usually benign and self-limiting. He also reminds men to be more “breast-aware” and have more empathy for all the breast issues women have to go through.

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