 Introduction/Background Men with breast symptoms are typically concerned about the cause of their problem and whether or not it is due to breast cancer. The majority of male breast problems are benign, with gynecomastia as the most common cause of a palpable mass, breast enlargement, or pain [1-3]. Gynecomastia occurs physiologically in neonates and adolescents and with aging but can occur at any age as a side effect of many medications and recreational drugs, as a result of hormonal changes, and in the setting of chronic liver disease [4]. Although gynecomastia may present at any age, breast cancers usually occur in older men (median age of 63 years) [3,5]. Breast cancer in males accounts for <1% of all breast cancers. Although rare, breast cancer in men frequently presents with associated symptoms (eg, palpable lump, skin or nipple retraction, nipple discharge) and at an advanced stage (larger tumor size and a higher probability of nodal metastases) [6-8]. Because gynecomastia is a common entity, approximately 50% of men with breast cancer may have coexisting gynecomastia [9]. However, gynecomastia is not believed to be a risk factor for male breast cancer [10]. Although gynecomastia and breast cancer are the main considerations in most men with a palpable mass, other masses arising from the skin and subcutaneous tissues, such as lipomas, epidermal inclusion cysts, and oil cysts, are also commonly encountered. Pseudogynecomastia, which is due to excess fatty tissue deposition in the breasts, is also common, especially in patients with an elevated body mass index. If the differentiation between benign disease and breast cancer cannot be made on the basis of clinical findings, or if the clinical presentation is suspicious, imaging is indicated [1,2]. Discussion of Procedures by Variant Variant 1: Male patient of any age with symptoms of gynecomastia and physical examination consistent with gynecomastia or pseudogynecomastia. Initial imaging.
Evaluation of the Symptomatic Male Breast.  Introduction/Background Men with breast symptoms are typically concerned about the cause of their problem and whether or not it is due to breast cancer. The majority of male breast problems are benign, with gynecomastia as the most common cause of a palpable mass, breast enlargement, or pain [1-3]. Gynecomastia occurs physiologically in neonates and adolescents and with aging but can occur at any age as a side effect of many medications and recreational drugs, as a result of hormonal changes, and in the setting of chronic liver disease [4]. Although gynecomastia may present at any age, breast cancers usually occur in older men (median age of 63 years) [3,5]. Breast cancer in males accounts for <1% of all breast cancers. Although rare, breast cancer in men frequently presents with associated symptoms (eg, palpable lump, skin or nipple retraction, nipple discharge) and at an advanced stage (larger tumor size and a higher probability of nodal metastases) [6-8]. Because gynecomastia is a common entity, approximately 50% of men with breast cancer may have coexisting gynecomastia [9]. However, gynecomastia is not believed to be a risk factor for male breast cancer [10]. Although gynecomastia and breast cancer are the main considerations in most men with a palpable mass, other masses arising from the skin and subcutaneous tissues, such as lipomas, epidermal inclusion cysts, and oil cysts, are also commonly encountered. Pseudogynecomastia, which is due to excess fatty tissue deposition in the breasts, is also common, especially in patients with an elevated body mass index. If the differentiation between benign disease and breast cancer cannot be made on the basis of clinical findings, or if the clinical presentation is suspicious, imaging is indicated [1,2]. Discussion of Procedures by Variant Variant 1: Male patient of any age with symptoms of gynecomastia and physical examination consistent with gynecomastia or pseudogynecomastia. Initial imaging.