Dear Dr G,

October is generally dedicated to Breast Cancer Awareness and as such, it is called Pink October

I would like to take this opportunity to ask about a mystery in my breasts.

I am a man in my late forties with strange sensations in my chest recently.

It started as tingling in both nipples, followed by constant nagging discomfort in both breasts.

I understand from your last article that breast cancer can occur in 1% of men.

Thankfully, there is no lump that I can feel in my breasts.

My wife thinks it is all in my mind, but I was bothered enough to seek specialist help.

I was referred to a breast specialist for the pain, and attending such a clinic felt awkward.

The specialist said I have mastalgia, possibly due to hormonal changes.

She assured me it is nothing serious, but if the pain persists, I may need tests and treatment.

In the spirit of Pink October, I would like to put Dr G on the spot about mastalgia.

Can you tell me the meaning of mastalgia?

What can cause breast pain in men, what should I look out for and what treatment is available for me.

Please help.

Regards.

Mastalgia Matthew.

Mastalgia derives from “mast‑”, meaning breast, and “‑algia”, meaning pain. Mastalgia can range from mild tenderness and burning discomfort to severe throbbing or stabbing chest pain. In women, such non-serious pain can affect one or both breasts and often recurs before menstruation.

Apart from menstruation, causes of breast pain in women include oral contraceptive pills, early pregnancy and the onset of menopause. Only about 2% of breast pain is related to breast cancer. Breast tissue in adolescent boys does not progress despite hormonal surges.

Although breast tissue in men is functionless, men still face risks of breast conditions. Common causes of breast pain in men include trauma, fat necrosis, gynaecomastia and, rarely, breast cancer. When breast tissue is badly damaged, especially after sport or road traffic accidents, cells can die and regenerate.

This process can cause single or multiple lumps of fat necrosis in the chest. The skin over a lump may appear red, bruised or dimpled, mimicking cancerous changes. Ultrasound and biopsy may be necessary to confirm the diagnosis. Fat necrosis is generally self limiting as dead tissue dissolves over time.

In severe cases, surgical removal of dead tissue may be necessary. Muscular strain after heavy lifting or press-ups is another common cause of breast pain in men. Strain to the pectoralis major and minor can induce nagging chest pain.

Although pain may not originate in breast tissue, it can be felt in the breast area. Such musculoskeletal injury usually requires rest and stretching to aid healing and pain relief. Gynaecomastia and breast cancer can also concern men with mastalgia, and it is the benign overgrowth of male breast tissue caused by an imbalance of male and female hormones.

The condition is usually painless, but many men feel self-conscious and experience discomfort. In some cases, overgrown tissue may harbour a lump that could represent early breast cancer. Although gynaecomastia is benign, persistent discomfort may lead to treatment with tamoxifen, radiation or surgery.

Options include liposuction or mastectomy for symptom relief. Other breast conditions linked to mastalgia include breast cysts and fibroadenoma. Breast cysts are common in women but rare in men, and one type is a fibroadenoma; this is a non-cancerous lump in the fibro‑glandular breast tissue.

These lumps may or may not be palpable, but breast discomfort is a common symptom. Breast cancer in men is rare, but it usually presents as a lump with skin puckering or dimpling. Such features require urgent surgical assessment, and non-breast causes of chest pain can also present as mastalgia. Pain location and cause may be vague and difficult to pinpoint.

Chest discomfort is commonly associated with heartburn, respiratory conditions and heart disease. Persistent breast pain of unknown origin may warrant endoscopy, imaging or an ECG. These help to identify non breast conditions that can mimic mastalgia. Breast pain is common in women across their lives.

Monthly hormonal changes and pregnancy can present as mastalgia. In the spirit of Pink October, it is important to be breast cancer aware and to show empathy. When men with mysterious breast discomfort put Dr G on the spot, he usually reassures them.

He explains the condition is usually benign and self-limiting and also reminds men to be more “breast aware” of the issues women face, with empathy.