Breast cancer in men is an uncommon condition that accounts for approximately 1% of all breast cancers (1). Because of its rarity, it is difficult to determine specific factors that may predispose to male breast cancer. Unlike breast cancer in women, where large clinical trials are possible and universally conducted, there is a paucity of data related to the biology, risk factors, diagnosis, and treatment. Most algorithms are based on management strategies that are in place for women. This chapter provides an overview of current concepts associated with male breast cancer with an emphasis on reconstructive options following surgical management.

As mentioned, breast cancer in men is extremely rare; however, the incidence appears to be on the rise. In 2005, it was estimated that 1,690 new cases of male breast cancer would be diagnosed and that 460 men would die of it (2). Over the last 25 years, there has been a 26% increase in male breast cancer (3). The mean age for male breast cancer is 67 years, although there does not appear to be a specific age range in which these malignancies can occur, given that they have been reported in young and elderly men. Risk factors for male breast cancers have not been well defined, although there is an association with family history, Klinefelter’s syndrome, radiation exposure, and BRCA2 gene mutation (4). Other factors such as testicular disorders, liver disease, obesity, and estrogen exposure have been implicated (4,5,6). An association with gynecomastia has not been demonstrated, although male breast cancer and gynecomastia do share some common risk factors (4,6). In a recent study from the Veterans Affairs hospital in Cincinnati, Ohio, the ratio of breast cancer in men (n = 612) to that in women (n = 2,413) was determined and subdivided into two racial groups: white and African American (7). Of interest, the percentage of breast cancer in African American patients was higher in males than in females (23% vs. 16%). This is in contrast to the situation in white patients, where the percentage was greater in females (81% vs. 75%)

Most breast cancers in men will present as a painless lump in the breast. Other presenting signs include nipple retraction and bleeding. These lumps are usually located in the central or subareolar portion of the breast in approximately 75% of cases and along the periphery in 25% (4). Itching and pain are not common, but nipple discharge has been demonstrated in approximately 75% of cases (4,6,8). Because the male breast is small and male breast cancer is frequently invasive at the time of diagnosis, regional spread is observed at the time of presentation in approximately 50% to 60% of patients and manifests as a painless axillary mass (5,8).

Most breast cancers in men are invasive ductal (4,5). This is primarily because there is very little lobular tissue and an abundance of ductal elements in the male breast. Ductal carcinoma in situ are lobular carcinoma are uncommon, accounting for <10% of the malignancies (8). Estrogen and progesterone receptors are expressed in greater than 80% of male breast cancers (4,6,9).

Diagnosis of male breast cancer occurs in a similar fashion to that for women and includes breast imaging and biopsy. Imaging studies such as mammography and ultrasound are most useful. It has been demonstrated that mammography in males has a sensitivity of 92% (4,6). The most common mammographic finding is a speculated mass. It is not microcalcifications (10). Ultrasound can also be useful demonstrating the mass in the majority of patients. Screening studies for male breast cancer are of little value because of the very low incidence of these tumors.

Tissue diagnosis is best achieved using fine needle aspiration or a core biopsy. Because these lesions are palpable and the breast volume is relatively low, these lesions are easily accessed with these techniques.