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Mammography in men. Gynecomastia of the mammary glands

Various diseases The male breast has characteristic mammographic features that correlate with pathological characteristics. Breast cancer in men is usually subareolar and eccentric to the nipple. Compared with breast cancer in women, breast cancer in men has the characteristics that its borders are often well defined and calcifications are less common. Gynecomastia most often manifests itself as a fan-shaped spreading compaction emanating from the nipple and gradually dissolving into the surrounding fatty tissue. With gynecomastia, there may be extensions into the surrounding fatty tissue, and in some cases have a heterogeneous density reminiscent of the female mammary gland. Although breast cancer in men has natural mammographic signs, there are certain differential diagnostic problems with other nodal pathology. Mammographic features of gynecomastia quite clearly distinguish it from cancer, but in in rare cases Gynecomastia can closely resemble cancer. In some cases, it can be mistaken for gynecomastia chronic inflammation. All mammographically transparent formations in the male breast are benign, as are the corresponding formations in the mammary gland in women.

Mammography for gynecomastia

Gynecomastia is quite common. According to Nutall, up to 57% of men over 44 years of age have palpable breast tissue. Gynecomastia is characterized by hyperplasia of the ductal (ductal) and stromal elements of the male mammary gland. Clinically, gynecomastia manifests itself as a soft, mobile, tender mass in the retroareolar space. The presence of gynecomastia is often combined with an increased level of estradiol in the serum and a decrease in testosterone levels. This increased estradiol-testosterone ratio may arise from physiological changes in puberty and with aging, but may also be due to endocrine pathology, the use of hormonal drugs, systemic diseases, tumors and certain medications. Three mammographic types of gynecomastia have been described:

    nodular (nodular),

    dendritic (fibrous)

    diffuse type.

Nodular (nodular) mammographic type of gynecomastia

It has the appearance of a fan-shaped seal spreading from the nipple; it can be symmetrical, or more pronounced in the outer quadrant. The lump usually merges with the surrounding fat, but may be more spherical. The nodular type correlates with the pathomorphological classification of Florida (active) gynecomastia, which is considered early phase gynecomastia. At histological examination This type of gynecomastia is characterized by hypoplasia of the intraductal epithelium, with a few cellular stroma and surrounding edema.


Dendritic mammographic type of gynecomastia

The dendritic type of gynecomastia manifests itself in the form of a retroareolar soft tissue formation, with radial outgrowths extending deep into the adipose tissue. Dendritic type correlates according to pathomorphological classification with fibrous form gynecomastia, which is considered to correspond to long-term existence of gynecomastia. The histological characteristic of fibrous gynecomastia is ductal proliferation with dense fibrous stroma.

Diffuse mammographic type of gynecomastia

With the diffuse (glandular) type of gynecomastia, there are mammographic signs similar to the appearance of heterogeneously dense female mammary gland

The above mammographic types of gynecomastia allow us to describe the vast majority of cases. Less common are minor forms of gynecomastia, which are difficult to classify into any group based on mammography.

Pathology of the mammary glands in the form of fibrocystic transformation is called mastopathy. This disease is classified as a female disease, although men also have similar conditions. In representatives of the stronger sex, the mammary glands are more often affected in adolescence. But sometimes painful lumps occur at other ages (including childhood and old age).

All benign diseases mammary glands in men, occurring with tissue hypertrophy is called gynecomastia(see Figure 1).

Rice. 1 - Hypertrophy of the mammary glands in men - gynecomastia (before and after surgery).

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Mammary (breast) glands are formed during the period intrauterine development both boys and girls. Before puberty (puberty), differences in anatomical structure This area is practically not observed. Then, in teenage girls, glandular tissue grows under the influence of estrogens, gestagens, and prolactin. The volume, shape, and structure of the organ changes. In young men, the mammary glands practically do not develop. In adulthood, men have an areola of relatively small diameter and a nipple 2-4 mm high. The mammary glands are located in the spaces between the fourth and fifth ribs to the left and right of the midline. The organ tissue (when examining a macroscopic specimen) has a whitish color. The lobules and passages are poorly developed and short. The normal thickness of the mammary gland in a man is up to 5 mm, and the width is up to 15 mm.

The histological structure is divided into 2 sections:

  • secretory (consists of epithelial ducts);
  • interstitial (consists of connective tissue).

Affects glandular tissue in men a whole series hormones. The main role belongs to androgens, prolactin, estrogens, gonadotropins, somatotropin. In this case, sex steroids have a greater effect on the epithelial ducts (parenchyma), and prolactin has a greater effect on interstitial tissues.

What is gynecomastia?

Hypertrophy of the mammary glands in men is called gynecomastia. The increase may be due to different tissues. If the volume increases due to subcutaneous fat, then gynecomastia is false. Increased size due to glandular tissue is called the true form of this condition. Quite often, gynecomastia is considered mixed (the tissue contains both glandular and fatty components (see Fig. 1)).

Rice. 2 - Gynecomastia caused by the proliferation of glandular tissue and subcutaneous fat (mixed gynecomastia).

False gynecomastia usually occurs with, and true and mixed are manifestations hormonal imbalance or serious illness.

Stages of development of gynecomastia:

  • proliferation of the thoracic ducts;
  • proliferation of the glandular component;
  • fibrous proliferation (proliferation of connective tissue).

Gynecomastia is considered a normal variant:

  • in newborns (determined in 50% of boys);
  • in adolescents (detected in 40-60% of young men);
  • in the elderly (occurs in 25-30% of men over 50 years of age).

Enlargement of the mammary glands in newborns is associated with exposure to maternal estrogens. Gynecomastia usually goes away in the first month after the baby is born.

Hypertrophy of glandular tissue in boys during puberty is associated with hormonal changes in the body. Breast enlargement resolves on its own within 6-24 months.

In older men, gynecomastia occurs due to a fall and the occurrence of relative.

In young adult men without excess weight, gynecomastia is relatively rare (10-20%).

Table 1 - Degrees of mammary gland hypertrophy.

These grades are used to evaluate true and mixed gynecomastia.

Pathological causes of gynecomastia

Breast hypertrophy in men can occur due to physiological or pathological reasons. The first group includes all natural etiological factors(aging, puberty etc.).

TO pathological reasons include:

  • genetic diseases (Klinefelter syndrome);
  • tumors with hormonal activity;
  • liver failure;
  • taking certain medications;
  • starvation.

One in 500 newborn boys is crated extra chromosome(47,XXY versus the usual 46,XY). Such children subsequently develop all the signs of Klinefelter syndrome. They include characteristic appearance, hypogonadism, infertility, erectile dysfunction. Also, from adolescence, patients experience gynecomastia.

Most pronounced change hormonal levels and the appearance of gynecomastia is provoked by neoplasms of the testicle, adrenal cortex, and pituitary gland. Such tumors can be a source of estrogens, gestagens, androgens. Prolactinoma of the pituitary gland is also relatively common. In this case benign neoplasm releases excess levels of prolactin into the blood.

Thyrotoxicosis is accompanied by gynecomastia in 20-40% of men. Excess leads to activation of the reticular zone of the adrenal cortex. Endocrine cells This area produces androgens. But these sex steroids, due to thyrotoxicosis, quickly undergo transformation into. As a result, a relative predominance of female steroids is formed in the body.

Excessive aromatization of testosterone in peripheral tissues is provoked by metabolic syndrome(see Fig. 3). The pathology is based on insufficient tissue sensitivity to pancreatic insulin. This condition is also often accompanied by hypogonadism. Testosterone is not secreted enough, since the testicles can be damaged by hyperglycemia and hypercholesterolemia, characteristic of metabolic syndrome.

Rice. 3 - Influence increased activity aromatase on androgen levels in men.

Fasting, stress, severe somatic diseases sometimes disrupt the hormonal balance of the male body. If there is a relatively large amount of estrogen, then gynecomastia naturally appears.

From medicines And narcotic substances hypertrophy of the mammary glands is provoked by:

  • antiandrogens (flutamide, veroshpiron, finasteride);
  • androgens;
  • anabolic steroid;
  • antiretroviral drugs (efavirenz, etc.);
  • sedatives (diazepam);
  • antidepressants;
  • antibiotics;
  • chemotherapeutic agents;
  • cardiac glycosides (digoxin);
  • antihypertensives (calcium channel blockers);
  • alcoholic drinks;
  • drugs (opiates, amphetamines, etc.).

It is known that estrogen levels can also be increased biologically active additives to food, some products, cosmetics.


Rice. 4 - Enlargement of the mammary glands, provoked by the use of anabolic steroids.

Symptoms of breast pathology in men

Signs of gynecomastia can be mild or quite severe.

The main complaints in men associated with this disease:

  • swelling in the nipple area;
  • pain in the nipple area;
  • discomfort and feeling of constriction in the projection of the pectoral muscles;
  • nipple discharge;
  • increased pigmentation of the areola;
  • an increase in the volume of soft tissue in the pectoral muscles.

When feeling their breasts, men may independently discover a small round formation located behind the areola.

The patient also notes the accumulation and sagging of adipose tissue in the chest area. Externally, the male body begins to resemble a female one (visible mammary glands are formed).

Usually the changes are bilateral in nature, that is, the right and left gland. If the increase occurs only on one side (Fig. 5), then the risk of a malignant process is higher.

Rice. 5 - Uneven hypertrophy of the mammary glands may indicate a malignant process.

Examination for mastopathy in men

Boys and men with new-onset gynecomastia should definitely undergo comprehensive examination. Usually this condition is benign and safe for health. In many cases it does not require treatment. However, there are situations where mammary hypertrophy occurs due to malignant neoplasms or other serious illnesses requiring immediate medical intervention.

Diagnosis can be carried out by a doctor general practice, therapist, surgeon, endocrinologist, andrologist, oncologist, etc.

Standard examination includes:

  • collection of information (history);
  • inspection;
  • palpation (feeling);
  • ultrasound examination;
  • hormonal profile;
  • biochemical blood test;
  • mammography;
  • tomography;
  • puncture.

An integrated approach allows us to clarify the presence, nature and degree of gynecomastia, as well as its causes.

Treatment of mastopathy in men

Physiological gynecomastia usually goes away on its own and does not require special treatment. During adolescence, some patients require consultation with a psychologist to adapt to the characteristics of growing up and changes in their own body.

If hypertrophy of the mammary glands led to endocrine diseases(thyrotoxicosis, hyperprolactinemia), then the patient is recommended to primarily treat these pathologies.

If gynecomastia occurs due to hypogonadism, then the patient may be prescribed.

Surgical treatment is carried out:

  • with a pronounced cosmetic defect;
  • with fibrosis of the mammary glands;
  • with nodal forms of the disease;
  • if an oncological process is suspected.

The operation includes mastectomy () and liposuction (removal of fatty tissue).

Endocrinologist Tsvetkova I.G.

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What a man needs to know about female and male breasts.

How does the structure of the male mammary gland differ from the female one?

Almost nothing except the size and degree of development of glandular tissue.

Why do men need them?

No way!

How to care for them?

Conduct regular self-examination for lumps and nipple discharge, avoid injury, and maintain hygiene.

What to pay attention to and what diseases of the mammary gland can men have?

You need to pay attention to changes in size (enlargement of one or both glands), changes in color (redness), the presence of compactions in the glands or in the projection of the axillary lymph nodes, the presence of discharge from the nipples ( spotting especially dangerous), the appearance of ulcers on or near the nipple.

Does breast cancer occur in men?

Happens. Breast cancer is 100 times less common in men than in women.

Men, as a rule, pay attention to changes in the mammary glands late and seek help from a doctor with already advanced processes in the glands.

Since the size of the mammary glands in men is small, the tumor grows quickly and penetrates beyond the organ.

Who can get this terrible disease?

The disease can occur in any man, but men should take special care of their health if they have relatives with breast cancer in their family, whether in men or women.

Genetic factor is incredibly important.

The risk group includes people who have diseases endocrine system, including diabetes mellitus, thyroid diseases and others. Long-term use hormonal drugs may serve as a risk factor. It is necessary to avoid trauma to the mammary gland.

Remain relevant bad habits: anything to which the word abuse can be applied. In athletes taking anabolic steroid drugs, the risk of developing breast cancer and other diseases increases.

What should you do if, during lovemaking, a man discovers a lump in his beloved’s chest? Believe me, this happens often.

Firstly, there is no need to panic, because not every formation in the mammary gland is cancer.


-This may be a manifestation of cystic - fibrous mastopathy
-it could be a cyst
-it could be benign tumor, etc.

One thing is certain: you need to calm the woman down and gently insist on an immediate examination.

You need to contact a mammologist or oncologist, the doctor will conduct an examination and prescribe the necessary additional examinations that will clarify the nature of the formation in the mammary gland.

The most reliable methods diagnostics are mammography and ultrasound examination of the mammary glands.

If necessary, a targeted biopsy will be performed to clarify the structure of the formation.

Secondly, even malignant tumors detected at early stages, and with timely start proper treatment very treatable good results and preserving women’s health and quality of life. It is necessary to provide maximum moral support to the woman and steadfastly go through the entire treatment path with her, constantly instilling in her confidence in a favorable outcome of treatment.

What are the risk factors for developing malignant and other breast diseases?

Genetic predisposition to tumors
- stress
- overweight
- smoking
- alcohol abuse
- abortions, absence of pregnancies
- absence or irregular sex life
- injuries and inflammatory diseases mammary glands
- presence of diseases of the endocrine system:
-thyroid gland, diabetes mellitus
- diseases gynecological organs
- long-term wearing of a synthetic and tight bra
- prolonged and frequent exposure to the sun or solarium

Who needs a mammogram and how often?

Mammography is mandatory for women whose close relatives: mother, grandmother, sisters, especially on the maternal side, have had breast cancer.

Such women need to be examined annually, starting from the age of 35, and sometimes twice a year.

All other women over 35 - 40 years old are recommended to undergo examination 1-2 times a year for preventive purposes.

In all developed countries, all women over 35-40 years old undergo this procedure at least once a year or every two years.

The procedure takes several minutes and allows one to detect the presence of a tumor several millimeters in size, when neither the woman herself nor the doctor during examination can detect the tumor due to its small size.

Breast cancer does not grow very quickly, it will pass more than a year, and sometimes several years, before it can be detected during self-examination or examination by a doctor.

Time will be lost and the result of treatment will be completely different. When found malignant tumor on early stage and timely treatment, the woman retains her ability to work and quality of life.

Why don't all women get mammograms?

There are many reasons. Some women do not have information, some women are limited in time, busy with family, children and others constant problems, but most women are simply afraid to go for an examination and find out the truth about themselves.

Often husbands bring their wives by the hand and ask them to undergo an examination. Well done!

Sometimes at lectures I ask men: has their wife, (mother, sister, daughter) had a mammogram? The most common answer: no.

Let's get used to taking care of our health and that of our loved ones.

Can men have mammograms?

For diagnostic purposes, men often undergo mammography; the examination is carried out in the same way as in women.

This study allows you to quickly and correctly diagnose and begin the necessary treatment.

For preventive purposes, mammography is rarely done in men.

Families are known where breast cancer in men occurs in every generation. Men in such families with high risk tumor development require regular monitoring by an oncologist and, if necessary, additional examinations, including performing mammography and ultrasound examination of the mammary glands.

If a woman has mammary glands different sizes?

Asymmetry of the mammary glands is quite common. This is not a disease, but it is necessary to monitor the mammary glands and conduct self-examination at least once a month.

If a woman (man) had mammary glands of the same size and the size of one gland has changed (increased or decreased), you should immediately consult a doctor.

What can a man do for a woman's health?

Take care of the woman. Help her eliminate those risk factors that a woman can eliminate.

Quit smoking, normalize sleep, watch your weight, sleep 8-9 hours, have sufficient physical activity, and one of the most important conditions– eliminate stress. E

is that impossible? It is impossible to completely eliminate stress, but one must strive for this, and if the situation cannot be changed, then one must develop the correct reaction to it.

Caring for a woman also means preventing unwanted pregnancy. A

boarding causes enormous harm both physically and psychological health women.

Where can I get tested?

We invite women who monitor their health and value their time to undergo examination in a modern medical institution– Perinatal medical center, which is located in a convenient location in the city.

In our department, you can undergo a mammography examination using modern equipment, at any time convenient for you, since we work around the clock.

Women 40 years of age and older should be screened at least every 2 years.

High-risk patients (risk groups) should undergo the procedure with more early age 1 time per year.

Mammography is performed from 5 to 11 days menstrual cycle, counting from 1 day.

During menopause, the study is performed any day. Special training not required.

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Tumor of the mammary glands in men occurs 100 times less frequently than in women. Thus, we can say that less than 1% of all cases of breast tumors occur in men.

After the doctor or the patient himself has discovered a tumor or some other neoplasm in the chest area, certain research methods are carried out to clarify the diagnosis.

  • Mammography. Mammography is x-ray method breast studies. For this purpose two x-ray– front and side. After this, a radiologist examines the resulting images. If, based on the images obtained, there is a suspicion of pathology, then additional pictures a specific area of ​​the chest - these are so-called targeted images.
  • Ultrasound examination. This method research has gained well-deserved popularity among doctors and patients due to its low cost, simplicity and safety for the patient. The principle of this method is that based on different passages ultrasound through certain fabrics a picture is created on the computer. Judging by it, the doctor assesses the condition of tissues and organs. If any tumor-like formation is detected on mammography or during manual examination, then ultrasound can determine whether the tumor is a “solid” formation (for example, cancer or fibroadenoma) or hollow with fluid content (cyst). Unfortunately, ultrasound does not allow one to determine the benign or malignant nature of a tumor.
  • Examination of nipple discharge. If there is discharge from the nipple, it must be sent for cytological examination to identify possible cancer cells.
  • Biopsy. A biopsy is a study of a piece of tissue taken from a tumor to determine its structure. Only a biopsy can reliably establish a diagnosis of cancer. A biopsy is performed for any pathological changes in the chest. There are several biopsy techniques, each of which is indicated in certain cases. A biopsy is an invasive research method, that is, it requires the use of instruments that violate the integrity of the skin.
  • Needle biopsy. This test is performed using a needle and syringe. A needle is inserted into the tumor and its tissue is “pumped out” with a syringe. Next, the resulting tissue is examined for the presence of cancerous (atypical) cells. Sometimes the tumor is not detectable by touch, then ultrasound or ultrasound is used to perform a needle biopsy. X-ray examination, which help guide the needle into the thickness of the tumor.
  • Stereotactic needle biopsy. In this case, several tissue samples are taken from the tumor. As was said, if the tumor cannot be palpated, ultrasound or mammography comes to the rescue.
  • Incisional biopsy. This method is more like surgery. In this case, a larger area of ​​tissue is taken than with a conventional needle biopsy. Often, an incisional biopsy is performed when a needle biopsy is uninformative or when the tumor is too large. The purpose of this procedure is to make a diagnosis. Since in this case only part of the tumor is excised. this procedure in no way relates to medicinal. Usually, if a man is diagnosed with breast cancer, it is completely removed.
  • Excisional biopsy. This biopsy method involves completely removing the tumor from the breast. This is the most exact method cancer diagnosis. Both biopsy methods: incisional and excisional - can be performed on an outpatient basis, under local anesthesia. The purpose of these methods, as stated, is the diagnosis of cancer. Even if the entire tumor was removed during a biopsy, this does not mean that the patient is cured, since in any case a mastectomy is required.
  • Removal of lymph nodes for breast tumors in men
  • Diagnosis of breast tumor in men

Gynecomastia is a disease that causes enlargement of the mammary glands in men. It is caused by the proliferation of glandular tissue (breast tissue). There is also false gynecomastia, which occurs with obesity.

Why does gynecomastia occur?

  • Promotion in male body female hormones.
  • Decreased levels of male sex hormones (testosterone).
  • Use of certain medications.

In almost all cases, gynecomastia progresses spontaneously and therefore does not cause any discomfort to a man. However, if it persists for a long time, gynecomastia increases the risk of breast cancer. This disease is rare in men. But it can lead to consequences such as breast cancer, similar to breast cancer in women. This suggests that treatment for gynecomastia cannot be delayed. Symptoms characteristic of breast cancer: the appearance of a lump, bloody discharge from the nipple, the appearance of ulceration, skin changes at the site of formation, enlarged axillary lymph nodes.

Diagnosis of gynecomastia

After visiting the doctor, the patient will need to take a blood test for estradiol, testosterone, LH, prolactin, FSH, thyrotropin, liver enzymes, human chorionic gonadotropin, nitrogen, creatinine, urea.

The survey may be supplemented by instrumental methods, in order to find out the cause of gynecomastia. For example, for breast cancer, the following are prescribed additional procedures, such as mammography, biopsy, ultrasound examination of the axillary lymph nodes and breast.

Treatment of gynecomastia

Gynecomastia is very common today. Men, mammology is not only the concern of madams and mademoiselles, but you should also take care of your breasts.

Breast diseases can be caused by many factors. The cause of an unhealthy condition is, as a rule, an organ or organs that did not bother the patient at all all the time before contacting a specialist. Therefore, men, in order for your health to be restored, you need to undergo a comprehensive examination that will identify all the factors. possible threat, and also individual course therapy or surgical intervention and rehabilitation. It's pretty long time, which will cause a lot of nerves and worries about yourself.

But how easy it is to diagnose diseases at an early stage. How simple and necessary it is to be attentive to yourself! You are our support and protection. Don't leave your breasts aside, no matter how ridiculous it may seem to you. These are truly terrible diseases, mammological ones. Without proper diagnosis and timely treatment, the state of health falls under serious threat: every year, 2 out of 9 patients die from breast pathologies, the reason for which is a late visit to the mammology center. Half of them can be saved - and we do it every day!

Men, according to mammology, the most serious disease is gynecomastia. This is a benign enlargement of the mammary glands, which can be provoked by several factors:

1. liver disease, especially cirrhosis. It is necessary to take medications that will inhibit the development of cirrhosis and improve liver function.

2. hormonal imbalance. Overgrown glandular tissue is removed, and the activity of the glands is corrected, and the activity of the thyroid gland is also corrected.

3. long-term use hormonal drugs. It is necessary to reduce the number of devices used and include the use of homeopathic remedies.

Diagnosis of gynecomastia is a thorough examination of the organs representing potential threat men's health. Observation by a specialist endocrinologist and breast oncologist is a major part of your recovery.

How to cure gynecomastia?

There are two, fundamentally various methods Treatment: conservative and surgical.

Conservative treatment is carried out on an outpatient basis under the supervision of an endocrinologist. It depends on the form of the disease. The need for treatment of juvenile gynecomastia, choice of method and timing therapeutic measures are dictated psychological state sick. You can adhere to a wait-and-see approach, since most often after 2-3 years with juvenile gynecomastia, spontaneous regression of enlarged mammary glands occurs.

Indications for surgical treatment gynecomastia:

  • large volume of mammary glands
  • if gynecomastia is more than a year old
  • inefficiency conservative therapy
  • obvious cosmetic defect.

Surgical treatment consists of removing breast tissue through a periareolar incision, or removing fat using liposuction, or a combination of both methods. If a patient has pseudogynecomastia (fat deposits in the area of ​​the breast jelly), then the optimal treatment for gynecomastia is non-surgical laser liposuction.

Experts believe that in 30–70% of cases, breast cancer in men appears due to gynecomastia, including due to its nodular form. That's why full diagnostics gynecomastia using both clinical and x-ray method research helps to detect cancer at an early stage, and this determines the success of gynecomastia treatment.

The mammology center is your support and healthy future. Be careful and careful - the health of your breasts is your beauty and success!