Whats the next step?

[iron4life]

Docs,

 I noticed a small lump under my left nipple when I was a teenager and never really thought anything of it. As I’ve gotten older, it seems to have increased in size( about the size of an oval shaped golf ball now). My concern is that my mother is a recent ( last 5 years) breast cancer survivor and my my grandmother died from her fight with breast cancer. Additionally, I’ve had 2 other grandparents and uncle die from some form of cancer. As I’m about to get married and start a family in the near future, I’m concerned my gyno could eventually develop into breast cancer. With that, I’m wondering if getting insurance to cover it is even a possibility?

What would be the best first step in this process? Seeing a general practice doctor, going straight to an endocrinologist or scheduling a consultation with a plastic surgeon? My guess would be that I’d have to have some blood work done first.

Appreciate anyone’s help and look forward to getting this thing out of me.

Thanks,
R

 
 

 

[Litlriki]

While breast cancer does occur in men, it's much less common than in women.  It is more common in older men, and typically it raises concern that it's breast cancer, rather than just presenting as gynecomastia.  This may include other associated signs, such as skin dimpling near the mass.

Alternatively, the risk of breast cancer appearing in gynecomastia is very low.  In 20 years of treating gynecomastia, non-invasive breast cancer (ductal carcinoma in-situ or DCIS) has been found in 3 of my patients.  The fact that this is so rare means that health insurance companies will pay for you to have the mass evaluated, possibly including a biopsy, but they aren't likely to pay for treatment of your gynecomastia.  In other words, they might cover the cost of excising a breast lump, but if you need to have the area treated to get the best aesthetic outcome (including liposuction and any other skin or soft tissue contouring), that would not be included.  And they might only cover the cost of a needle biopsy.

If your concern is breast cancer, you should start with your PCP, and he or she will direct you accordingly.  If your concern is gynecomastia, then you can see a plastic surgeon, once your satisfied that the cancer question has been addressed.  In any case, the surgeon will send the tissue removed to the pathologist, as in the 3 cases I mentioned, and if cancer is present, it will most likely be diagnosed in the specimens removed.

Good luck,

Rick Silverman

[DrPensler]

I would recommend you see a plastic surgeon.If you are truly concerned about a malignancy a pericutaneous needle biopsy could be performed.