Painful Unilateral Gynecomastia

[TEJ]

I have a lump behind one nipple about 2cm.  I am 32 now and I have had it since I was about 12.  Recently I have been having dull pain thats radianting into my shoulder and toward my breastbone.  I had an ultrasound about 4 years ago and it came back negative.  I recently saw a surgeon (not a good experience), I asked about and hoped to get a biospy which from my reading appears to be the best test for diagnosis of malignancy.  He wouldnt hear it and began talking about payment plans.  Needless to say I have a consult with another surgeon, but not until march 6.  I was wondering if it would be useful to revisit my pcp and see if he can run some other tests.  I am willing to deal with the discomfort to avoid surgery but i am worried it is something more.  No nipple inversion, no drainage, and no discoloration just dull pain.

[Litlriki]

From your note, it's not clear to me if you are bothered by the appearance of your chest, or if you're simply looking to have the lump evaluated.  If it's the latter, you might visit a general surgeon, who could pursue a more traditional work-up for a breast mass.  This might include a mammogram and a needle biopsy, tests which might provide enough information to put your mind at ease.  Male breast cancer is uncommon, but it does occur. 

As plastic surgeons, depending on the nature of our practice, we are often focused on issues of aesthetics, and the surgeon you already saw may have felt that you were there to address the appearance, rather than evaluate the nature of the mass.  If you are looking to do both, you should confirm with the surgeon that the tissue that's removed is sent to pathology for evaluation. Breast cancer in gynecomastia specimens is very rare, except in cases where there is some suspicion beforehand related to the presentation and appearance.

Rick Silverman