Breast exams, mammograms, etc.

[maineguy79]

Hi guys,

I finally got up the courage to speak with my doctor about gynecomastia a few months ago. Due to the fact that one side is larger than the other and occasionally has some tenderness, my doctor referred me to a specialist -- a surgeon who deals primarily in breast cancer.    Needless to say, that scared me, but my doc assured me that it's just a precaution and that he doesn't think I have breast cancer.

Anyway, I saw the specialist today. He did a full exam, and wants me to have a mammogram and an ultrasound.

Have any of you ever had either of those procedures? If so, what was it like?

I'm always reminding my mom to get a mammogram every year... I never imagined that I'd be getting one too.  

[DrBermant]

Hi guys,

I finally got up the courage to speak with my doctor about gynecomastia a few months ago. Due to the fact that one side is larger than the other and occasionally has some tenderness, my doctor referred me to a specialist -- a surgeon who deals primarily in breast cancer.    Needless to say, that scared me, but my doc assured me that it's just a precaution and that he doesn't think I have breast cancer.

Anyway, I saw the specialist today. He did a full exam, and wants me to have a mammogram and an ultrasound.

Have any of you ever had either of those procedures? If so, what was it like?

I'm always reminding my mom to get a mammogram every year... I never imagined that I'd be getting one too. 

Asymmetric or Uneven Gynecomastia is not  uncommon. Major asymmetry is less common, but this week I had 3 consecutive cases of massive difference between the 2 sides. Now that is quite unusual. 

Tenderness is a normal Symptom of Gynecomastia and usually reflects gland stimulation.  Although I work with up to 8 gynecomastia patients a day, it is very rare that I ask for testing such as a Male Mammogram.  Not all mammography units are experienced in the male mammogram nor ultrasound.  Male breast cancer is very rare, but can happen. Bloody nipple discharge or other such symptoms can be important enough to trigger further evaluation and caution before elective gynecomastia surgery. 

When a patient already has a mammogram, I do like that they bring the films or disk so I can use them to supplement my exam.  However, I do not feel the cost nor extra radiation are worth it for one of my typical patients unless if I find something I do not like on my clinical exam or patient history.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[Dr. Elliot Jacobs]

Realistically, in a young, healthy male, breast cancer is virtually unheard of.  Can I argue with having a mammogram and sonogram "just to be safe"?  No, but on the other hand, I would rather make my determination based on clinical grounds (including a history and physical exam) and not rely on a mammo. There is also a radiation dose associated with a mammogram.

Mammograms and MRI's and sonograms on women are necessary -- you are trying to evaluate for a deadly disease which can, indeed, strike young women as well.  For every male breast cancer (usually found in much older men), there are 99 female breast cancers -- keep those numbers in perspective.

Dr Jacobs

[maineguy79]

Doctors, thank you for your replies.

My primary care physician did a complete physical and breast exam, and the physician I saw today (who is chief of surgical oncology at the local hospital) also did a full breast exam, and he is the one who is ordering the mammogram.

He said that he didn't feel any lumps or masses, and I'm not having any pain or discharge. All of my bloodwork, as well as a brain MRI to rule out pituitary adenoma, has come back normal.

In light of the physician's credentials and status, I feel like I'm not in any position to question his judgment... but after reading your replies, and knowing that you both specialize in this sort of thing, I can't help but wonder if I should speak up and say "Do I really need a mammogram?"  I know that it's ultimately my decision, but now that both of you have questioned the necessity of it, I'm not really sure what to do. 

[jsboob]

Ive had an ultrasound before. I had a lump in one of my breasts & they sent me to breast clinic.
Ultasound is nothing, but they then did a "core biopsy"- now that DOES hurt! they stick a large bore hollow needle attached to a spring loaded device into the suspicious area & when the spring is released it cuts a "spaghetti like" chunk of tissue out to be analysed!
I was all clear thankfully. (Fibrous tissue she said)
The breast doc told me the main reason guys who get breast cancer ( it can happen but is rare) usually die from it is that they dont get it seen to until its too late. This is usually due to ignorance ( "surely guys dont get breast cancer?") or scared to go to the doc.
She also said mammograms arent a lot of help diagnosing a guy with (true) gynecomastia as the breast tissue tends to be more dense (proportionally less fat & more actual breast tissue) than a female.
This doc is a top consultant breast surgeon so I think she does know what she is talking about!

BTW, you do not have to have gyne to develop breast cancer!

I always do a self exam while im in the shower.

[maineguy79]

Thanks for your reply, js. It sounds like an ultrasound and core biopsy were warranted in your case, due to the lump. I'm glad that they didn't find anything bad!

Since I don't have any lumps, I'm kind of scratching my head at this point and wondering if the mammogram is really necessary, especially after reading the replies from Drs. Jacobs and Bermant.

I do have a couple of family members who've had breast cancer, and I did mention that to the surgeon. Maybe that's why he's acting in an overabundance of caution...? Still, I don't seem to have any signs or symptoms... unless he felt something and isn't telling me (which seems unlikely)...

[RadG]

I had a mammogram about 4-5 years ago. The doctor ordered it just to have it done, not because she found anything. Well it was different and if you can get past the whole only guy there and a form letter that refers to you as either Ms or probably Mrs depending on marital status, you should be fine. The squishing was a little uncomfortable but not painful and it only lasted a couple of seconds.

[maineguy79]

Drs. Bermant and Jacobs, I know you're both very busy but was wondering if you could comment further on the concerns I mentioned above. I spoke with the doctor's secretary today and his notes say "hypertrophy in the left breast, I do not feel any lumps, am recommending mammography and ultrasound."

I have absolutely no idea what to do at this point and would greatly appreciate any guidance.

Doctors, thank you for your replies.

My primary care physician did a complete physical and breast exam, and the physician I saw today (who is chief of surgical oncology at the local hospital) also did a full breast exam, and he is the one who is ordering the mammogram.

He said that he didn't feel any lumps or masses, and I'm not having any pain or discharge. All of my bloodwork, as well as a brain MRI to rule out pituitary adenoma, has come back normal.

In light of the physician's credentials and status, I feel like I'm not in any position to question his judgment... but after reading your replies, and knowing that you both specialize in this sort of thing, I can't help but wonder if I should speak up and say "Do I really need a mammogram?"  I know that it's ultimately my decision, but now that both of you have questioned the necessity of it, I'm not really sure what to do.  

[DrBermant]

Drs. Bermant and Jacobs, I know you're both very busy but was wondering if you could comment further on the concerns I mentioned above. I spoke with the doctor's secretary today and his notes say "hypertrophy in the left breast, I do not feel any lumps, am recommending mammography and ultrasound."

I have absolutely no idea what to do at this point and would greatly appreciate any guidance.

I am glad to help patients explore concerns and options during a consultation or a Preliminary Remote Discussion.  After learning details of history and the problem, specific advice can be given. Without such information, a valid recommendation cannot be made.

Any doctor providing specific advice on a forum has established a doctor patient relationship that he / she may be held accountable for.

If you want to learn more, Jane is my office manager.  She can normally be reached at our office by phone Monday - Friday 9-5 Eastern Time at (804) 748-7737.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[headheldhigh01]

i agree with the dr's as i read them that this is probably completely unnecessary.  the core concern of the dr's you were dealing with before is cancer, and those tests are simply not called for, the odds of your having it are distant.  they are, i think not very competently, applying female standards to men.  

this is silly.  if they were to examine me, OF COURSE they would find a lump, that's the form gyne often, though not always, takes in men.  a biopsy would be stupid, it's just GYNE.  a lump might be dangerous in women, in men it means you have the curse that brings us here to this site.  

yes it's a growth, but no, that does not mean it's dangerous.  apart from the fact gyne devastates men's lives, gyne is technically benign.  if you're not willing or able to live with it, it just needs to be removed by a competent ps so you can get on with what's left of your life.  

i think these guys you're dealing with know little or absolutely nothing about gyne, so they're doing the standard routine of cover your butt tests on a subject they really don't know, and that are a complete waste of money in your case.  

skip the tests, just get the gyne excised and gone.  problem solved.  

[maineguy79]

The irony is that my insurance will fully cover the mammogram and the ultrasound, but (to my knowledge) won't cover plastic surgery unless it's "necessary" for health reasons (and mental health doesn't count, apparently).

So I guess I'm kind of screwed either way.

[headheldhigh01]

thinking aloud.  try this.  

tell them you do not want the tests and biopsy.  BUT also tell them that if they fund the gyne operation, it will almost completely remove the suspect tissue, as well as the large mass of tissue surrounding it, thus safely and preventatively pre-empting the high-risk/cost problem the test recommendations were originally concerned with.  nip it in the bud, so to speak. 

insurance people are legalistic tightwads and not always rational, but the more i think about it, the more the idea grows on me.  from their perspective, it removes the risk of a potentially expensive liability.  

it's got to be worth a try, right?  

[maineguy79]

It's a great idea, actually... my only concern is that they would only pay for the left breast, since that's the only one that the doctors think is abnormal. (The right breast is plenty big, but the left one is very definitely bigger.)

Then I'd end up with a perfectly flat left breast and a huge (in comparison) right breast. 

[headheldhigh01]

get the dr's to recommend the prevention side of it.  technically the cancer risk in men, though low, is higher in gyne cases, therefore a risk on one side indicates prevention of an accompanying higher risk on the other because of the nature of the concern behind first case, i mean you've still got gyne on both sides, right? also, the cosmetic irregularity of the procedure is a direct effect OF the suggested procedure, and the cost of doing two sides instead of just one would be almost negligible as a fraction of the total package.  it's all upside and no down.  you could even suggest as a last resort, if you had to, that you'd pay the differential cost, which would only be a little extra surgeon's time since it would already be approved (if they did), i bet he'd be willing to estimate the extra difference cost component of it for you.  

i wouldn't say it might not be a long shot, but i'm still liking the idea.  just try working with it anyway and tell us how it goes.  

[steelhead]

Asymmetric or Uneven Gynecomastia is not  uncommon. Major asymmetry is less common, but this week I had 3 consecutive cases of massive difference between the 2 sides. Now that is quite unusual. 

Dr. Bermant how did you get that huge gland out without cutting it ? And thru that small incision ?