Q I am a 66-year-old man. I have had a small lump on the right side of my right nipple for more than two months. It is causing me pain.
I visited a polyclinic and the doctor there referred me to see another doctor at a restructured hospital.
The doctor at the restructured hospital examined me with an ultrasound scan and determined that the lump was not cancerous.
He said the swelling was due to the amount of medication I am consuming daily for my heart condition.
He has given me a letter to submit to the polyclinic doctor for my review.
Currently, the swelling and my pain has reduced but my right breast is still slightly larger than my left breast.
Out of fear and curiosity, I am seeking your help and advice on this issue.
A Like women, men too have some breast (glandular) tissue, though obviously not as much as women have.
Also, both men and women have both male hormones (testosterone) and female hormones (oestrogen).
But the relative amounts of each type of hormone are directly opposite for men and women. This means men have mostly testosterone and some oestrogen, and women have mostly oestrogen and some testosterone.
Apparent chest or breast enlargement in men is usually due to either a true increase and enlargement of the glandular tissue, which is a condition known as gynaecomastia; or due to an increase in weight, resulting in a condition called pseudogynaecomastia.
A doctor familiar with gynaecomastia can diagnose this condition with a clinical examination, which can be further checked with an ultrasound scan.
If there is any doubt, a procedure called a biopsy can be done to confirm the diagnosis.
In this procedure, the doctor uses a special needle to take a small tissue sample from, in this case, the enlarged breast.
This tissue sample is then sent for tests.
For a man in his 60s, there are quite a few causes for gynaecomastia.
The most common cause is a relative imbalance of the male and female hormones, as the amount of testosterone in a man decreases as he ages.
This is a normal process and is quite common.
Another common enough cause for gynaecomastia is the use of some types of medication. They include quite a few drugs for heart disease, such as digoxin (to treat heart failure and atrial fibrillation or abnormal heart beat), spironolactone (for heart failure and high blood pressure), calcium channel blockers and angiotensin-converting-enzyme (ACE) inhibitors (both treat high blood pressure).
Do ask your doctor if you are on any of these types of medication. If so, it is very likely that your doctor can swop them for some other type of heart medication.
Thus, most causes of chest or breast enlargement in men are benign and non-dangerous.
However, though it is rare, men can also get breast cancer, resulting in chest or breast enlargment.
This is why, if there is any doubt at all, a biopsy is recommended.
Some testicular tumours can also cause gynaecomastia, and you should also be checked for these to ensure that they are not the cause of your symptoms.
Also, in some men, long-term kidney, liver and thyroid problems can potentially cause gynaecomastia as well.
These more dangerous forms of breast enlargement in men are not very common.
If the doctors you have seen have excluded the more dangerous causes of breast lumps or enlargement as mentioned above, and if the lump is no longer painful, I do not think any further treatment is necessary, other than considering changing your heart medication, if you are on any.
If the imbalance in the sizes of your right and left breasts greatly distresses you, surgery to reduce the size of the enlarged breast is an option, but one that I would recommend only as a last resort.
DR ANTHONY TANG, consultant at the division of general surgery (breast surgery) at the National University Hospital
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