comscoreTreatment of Male Breast Cancer

Treatment of Male Breast Cancer

If you're a man who's been diagnosed with breast cancer, your treatment plan will be made up of one or more therapies that aim to remove and destroy the cancer cells.
 

If you're a man who's been diagnosed with breast cancer, your treatment plan will be made up of one or more therapies that aim to remove and destroy the cancer cells.

Decisions about treatments are based on a variety of factors including your overall health, the characteristics of the cancer, and your personal style of making decisions.

Treatment for male breast cancer can include surgery, chemotherapy, radiation therapy,
targeted therapy, hormonal therapy, and immunotherapy.

Surgery is often the first treatment for early-stage disease, although sometimes chemotherapy or hormonal therapy is given before surgery to help shrink the tumor. After surgery, other treatments such as chemotherapy, targeted therapy, radiation therapy, hormonal therapy, or immunotherapy may be recommended to get rid of any cancer cells that might have been left behind.

 

Finding a medical team for male breast cancer treatment

To get the best care after a breast cancer diagnosis, you need to choose a treatment team that includes specialists such as a breast surgeon, a medical oncologist, a radiation oncologist, and a genetic counselor. But because breast cancer in men is a rare disease, some doctors have little or no experience treating it. Men who’ve had breast cancer have reported, and some research has shown, that men are not always offered appropriate treatment options.

If possible, look into selecting a team at a major cancer center that has experience treating male breast cancer. If this isn’t possible in your individual situation, it’s a good idea to at least get a second opinion from a specialist (particularly a medical oncologist) at a major cancer center who is knowledgeable about male breast cancer. Second opinions can be useful for confirming whether your diagnosis is correct and whether your treatment plan is appropriate and complete. Many doctors now offer second opinions through telemedicine (either by phone or online video) and Medicare, Medicaid, and most private insurers are now covering telemedicine visits. Keep in mind that depending on the regulations in the state where you live, there may be some limitations on seeking a second opinion or setting up ongoing care through telemedicine with a doctor in a different state. You may need to get a written referral from a doctor in your own state, or you may be unable to get a consultation from a doctor who is not licensed to practice in your state.

Patient advocacy groups such as the Male Breast Cancer Coalition can help connect you
with doctors who are knowledgeable about male breast cancer.

Learn more about planning your treatment and getting a second opinion.

 

Surgery for male breast cancer

Most men diagnosed with early-stage breast cancer have surgery to remove the tumor and the surrounding breast tissue. The surgery may also include removing lymph nodes under the arm to check for cancer cells and determine if cancer has spread beyond the breast.

In addition to removing as much of the cancer as possible, the other purpose of surgery is to get more complete information about the cancer. Just like the pathology report you received after your biopsy, you will receive a pathology report after surgery. The information in the pathology report will help you and your doctors decide which treatments you’ll receive after the surgery.

Since most men diagnosed with early-stage breast cancer have cancer in one breast, the usual approach is to have surgery on just that breast. A bilateral mastectomy (the surgical removal of both breasts) is done in the rare situation that there is cancer in both breasts. Currently, it’s not widely recommended for men who have cancer in one breast to have a bilateral mastectomy to reduce the risk of someday developing cancer in the other, healthy breast. That’s because the risk of developing breast cancer in the other breast is relatively low for most men and hormonal therapy can help lower the risk further.

Still, some men who have cancer in one breast have chosen to get a bilateral mastectomy because they have a genetic mutation that raises the risk of breast cancer such as a BRCA2 mutation or a strong family history of breast cancer. There are also some men who haven’t been diagnosed with breast cancer but have those risk factors and have chosen to get a bilateral prophylactic mastectomy (the surgical removal of both healthy breasts to lower the chances of developing breast cancer in the future.

It’s important to talk with your doctors about all your treatment and risk reduction options, so that you can decide what’s best for your situation.

Types of surgery for early-stage male breast cancer
Modified radical mastectomy

The surgeon removes the nipple, areola (the dark, round area around the nipple), all of the breast tissue, and the skin over the breast. The surgeon also performs an axillary lymph node dissection, which means that some (on average, about 10) lymph nodes under the arm on the side of the tumor will be removed to check whether cancer has spread there.

Simple (or total) mastectomy

The surgeon removes the nipple, areola, all of the breast tissue, and the skin over the breast. Usually the surgeon also performs a sentinel lymph node dissection, which means that one or two (up to about five) lymph nodes under the arm on the side of the tumor will be removed to check whether the cancer has spread there. The sentinel lymph nodes are the first lymph nodes to which cancer might spread from the tumor. A lymphatic mapping procedure is done either the day before the surgery, the morning of the surgery, or during the surgery. This involves injecting a radioactive liquid, a blue dye, or both, underneath the nipple or near the tumor site to help the surgeon locate the sentinel lymph nodes.

If you are going to have a modified radical or simple mastectomy, you can ask your surgeon if a nipple-sparing mastectomy is an option for you. In a nipple-sparing mastectomy, the surgeon removes the breast tissue but leaves the nipple, areola, and the skin of the breast intact. You may need to have a breast surgeon and a plastic surgeon working together to perform your nipple-sparing mastectomy. In many cases men are not candidates for a nipple-sparing mastectomy because the cancer is very close to or involves the nipple and areola, and because they have less breast tissue overall, but it’s worth asking about it.

If you’re a man who has a larger volume or drooping breast, or extra loose skin and you’re going to have a mastectomy, you may want to ask your breast surgeon if he or she is able to do an aesthetic flat closure. This means that during the mastectomy procedure, extra skin, fat, and other tissue in the breast area are removed and the remaining tissue is tightened and smoothed out, so that you’ll have a smooth, flat chest contour. In some cases, it may be beneficial to have a breast surgeon and plastic surgeon working together during your mastectomy surgery to perform an aesthetic flat closure.

Radical mastectomy

This is the most extensive type of mastectomy. The surgeon removes the nipple, areola, all of the breast tissue, the skin over the breast, the chest wall muscles under the breast, and some of the lymph nodes under the arm. While radical mastectomy was the standard surgical treatment for breast cancer up until the 1970s, it is now only performed in the very rare situation that the tumor is growing into the chest muscles and chemotherapy was already given but it didn’t shrink the tumor.

Lumpectomy (also known as breast-conserving surgery)

The surgeon removes only the breast tumor (the lump) and some of the normal tissue that surrounds it. Some of the lymph nodes under the arm may also be removed.

In many cases, surgeons don’t recommend lumpectomies for men because of factors such as the size and location of the tumor and because they have less breast tissue overall. However, some men may be candidates for and may choose a lumpectomy. If a man chooses a lumpectomy, his doctors will typically recommend that he receives radiation therapy after the surgery to destroy any cancer cells that may be left behind.

Lymph node removal surgery

If your surgeon is going to remove some of the underarm lymph nodes to check whether they have cancer cells, he or she will usually do that at the same time as the mastectomy or lumpectomy. Occasionally, lymph node removal is done as a separate surgery. For instance, if cancer cells were found in the sentinel lymph nodes, an additional procedure may be needed to remove more lymph nodes.

What to expect with surgery for male breast cancer

Most of the surgeries for male breast cancer require general anesthesia, but in some cases local anesthesia and a mild sedative may be used.

The length of the hospital stay depends on factors such as the type of surgery, whether lymph nodes were removed, and the type of anesthesia that was used. After a mastectomy, you may spend a night or longer in the hospital. Staying overnight in the hospital is not usually necessary after a lumpectomy.

To learn more what to expect with breast cancer surgery.

One potential side effect of breast cancer surgery and radiation therapy that’s important to know about is lymphedema – abnormal swelling in the arm, hand, breast, or torso. Lymphedema may occur if you have lymph nodes removed and the normal flow of lymph (a thin, clear fluid that circulates throughout the body to remove wastes from tissues) is disrupted. Before your surgery, it can be helpful to learn about ways to prevent and manage lymphedema.

Breast reconstruction after mastectomy in men

After a mastectomy, your chest may be visibly uneven. If you feel self-conscious about the appearance of your chest on the side where the breast tissue was removed, the mastectomy scar, or the absence of a nipple, you can in most cases choose to get breast reconstruction.

Breast reconstruction procedures help to restore the natural shape and appearance of the chest and nipples. In men, breast reconstruction is usually not done at the same time as the mastectomy. If you opt for breast reconstruction, it will typically take place sometime after you’ve healed from the mastectomy and completed other treatments, such as radiation therapy and chemotherapy. The breast reconstruction process usually involves two or more procedures.

You may want to consider meeting with a board-certified plastic surgeon who specializes in male breast reconstruction before your mastectomy so you can discuss your options, decide if reconstruction is right for you, and include it as part of your treatment planning. However, even if it has been years since your mastectomy, you can still look into getting breast reconstruction. Most men who’ve had breast cancer surgery are candidates for breast reconstruction as long as they are healthy enough for additional surgeries.

Many plastic surgeons don’t have experience with reconstruction in men, but you don’t necessarily need to seek out one who does. It’s smart, however, to choose a plastic surgeon who has experience with all types of breast reconstruction in women, makes you feel comfortable, and wants to work with you. Breast reconstruction is usually covered by health insurance, but you may need to work with your plastic surgeon’s office or directly with your insurance company to communicate that the surgery is medically necessary and get approval in advance.

The following procedures can be used to improve the appearance of the chest after breast surgery in men:

Fat grafting

Fat grafting involves removing fat from another part of your body — usually your thighs, belly, or buttocks — by liposuction. The fat is then processed and injected in small amounts into the breast area. In the best case scenario, about half of the fat that is injected will stay there permanently, while the rest will be reabsorbed by the body. Several sessions of fat grafting may be needed to get the best results. Before injecting the fat, the plastic surgeon may insert small needles under the skin, through the mastectomy scars, to cut through the scar tissue and create space for the fat to be injected.

In men, fat grafting may be used on its own to reconstruct the breast or it might be used to enhance the results of other reconstruction procedures -- for example, by adding volume, filling in imperfections, or softening the appearance of skin that has been affected by radiation therapy.

Autologous (flap) reconstruction

Autologous or flap surgery uses tissue transplanted from another place on your body, such as your belly, thighs, or buttocks, to form a breast shape and in some cases to reconstruct the chest muscle if some of it was removed.

The most common type of flap surgery for in men is the latissimus dorsi flap procedure. It involves using an oval flap of skin, fat, muscle, and blood vessels from the upper back to rebuild the breast. For men who need a larger flap, the DIEP flap procedure may be the best option. In this surgery, fat, skin, and blood vessels from the lower belly are used to rebuild the breast.

Breast implant reconstruction

This involves reconstructing the breast with a small implant that is usually placed under part or all of the chest muscle (pectoralis). The type of implant most often used in men is custom made from solid silicone. More rarely, a small implant of the type used in women may be used in a man. These have a flexible silicone shell filled with either saline or silicone gel.

If radiation therapy is part of your breast cancer treatment plan, or if you’ve had radiation to the chest in the past, your doctors may recommend that you not get reconstruction with implants. Radiation often causes the skin over an implant to become tighter, tougher, and more rigid, and it can raise your risk of complications such as infection around the implant, capsular contracture, and extrusion of the implant.

Nipple reconstruction and nipple tattoos

If one or both of your nipples were removed when you had a mastectomy, you may choose to have surgery, tattooing, or both to recreate the nipple and the areola (the dark area around the nipple). Learn more about nipple reconstruction and nipple tattoos.

Scar revision

Scar revision procedures can improve the look of surgery scars (including by removing excess skin that was left behind) and can reduce discomfort from scars.

 

Radiation therapy for male breast cancer

Radiation therapy is a treatment that uses high-energy X-rays to kill cancer cells and shrink tumors. In men diagnosed with early-stage breast cancer, radiation therapy may be used to kill any cancer cells that remain after surgery. This reduces the risk of recurrence.

Radiation therapy is recommended for most men who get a lumpectomy (breast-conserving surgery).

Radiation therapy may also be recommended for some men who get a mastectomy, if:

  • the tumor was larger

  • cancer was found in multiple lymph nodes

  • cancer was found at the margin (or edge) of the breast tissue that was removed and additional surgery is not possible

Radiation therapy also may be recommended for some men diagnosed with metastatic breast cancer in order to relieve symptoms or help avoid complications from specific areas of spread. For example, radiation can help relieve painful bone metastases, decrease the risk of breaking a bone that's been weakened by cancer, or reduce neurological symptoms if the cancer puts pressure on nerves of the spinal cord or the brain.

If radiation is part of your treatment for early-stage breast cancer, it is usually given after surgery. If chemotherapy is planned after surgery, radiation usually follows chemotherapy. Hormonal therapy usually follows radiation therapy although it may be started at the same time as radiation therapy.

What to expect with radiation therapy

Most men who receive radiation therapy for early-stage breast cancer have treatment sessions once a day, five days a week (Monday through Friday), for about four to six weeks. Some men may be candidates for a hypofractionated (or accelerated) radiation schedule that involves receiving higher individual doses of radiation over a shorter total period of time.

During a radiation therapy session, you lie down on a treatment table while a large machine called a linear accelerator rotates around your body and delivers high-energy X-ray beams directly at the area of your body that needs to be treated. Depending on your individual situation, the treatment area may include the breast or chest wall, the nearby lymph nodes (in the underarm area, under the clavicle, and in the low neck), or another part of the body if the cancer has spread. Radiation therapy treatments are targeted in a way that minimizes damage to surrounding healthy tissues.

For each radiation session, you spend about 15 minutes on the treatment table but the delivery of the radiation itself takes only a few minutes.

The radiation treatment is painless, but it may cause some skin irritation over time and some fatigue. The radiation affects both healthy cells and cancer cells in the treatment area. However, it damages the cancer cells more than the normal cells.

Radiation therapy side effects

Men who receive radiation therapy as part of their breast cancer treatment may experience these common side effects:

  • mild to moderate fatigue

  • mild to moderate skin changes in the treated area, such as a sunburn-like reaction with redness, and possible itching, burning, blisters, or peeling

  • loss of chest hair and underarm hair on the side of the body that was treated with radiation, which can be temporary or permanent

Less common side effects may include:

  • a severe skin reaction that can cause skin peeling (desquamation)

  • arm swelling (lymphedema), especially if the lymph nodes were treated with radiation

  • shoulder stiffness

  • chest pain

  • heart problems

  • lung problems

When you start radiation treatments, your radiation oncologist will give you information about how to manage the skin side effects, which are the most common. Still, it’s important to tell your doctors about any side effects you’re having so they can help you manage them.

Learn more about Radiation Therapy Side Effects.

 

Hormonal therapy for male breast cancer

Hormonal therapy medicines help treat hormone receptor-positive breast cancer by lowering the amounts of certain hormones the body produces or blocking their effects on cancer cells.

After a breast tumor is removed, the cancer cells are tested to see if they have receptors for two hormones: estrogen and progesterone. Hormone receptors are proteins found within and on the surface of breast cells that pick up signals from hormones.

A tumor is called estrogen receptor-positive if it has receptors for estrogen. This suggests that the cancer cells may receive signals from estrogen that could promote their growth. The tumor is called progesterone receptor-positive if it has progesterone receptors. Again, this means that the cancer cells may receive signals from progesterone that could promote their growth.

Most male breast cancers are estrogen receptor-positive, progesterone receptor-positive, or both. This is known as hormone receptor-positive breast cancer.

The following hormonal therapy medicines are used to treat hormone receptor-positive breast cancer in men:

Tamoxifen is the hormonal therapy most commonly prescribed to men with hormone receptor-positive breast cancer. Tamoxifen works by blocking estrogen from attaching to the estrogen receptor on breast cancer cells. If estrogen can't attach to the cancer cell, it can't tell the cancer cell to grow. Tamoxifen is taken daily as a pill, typically for five years. It may be prescribed for a longer period in men who have a higher risk of breast cancer recurrence.

Aromatase inhibitors, including Arimidex (chemical name: anastrozole), Aromasin (chemical name: exemestane), or Femara (chemical name: letrozole) may be prescribed instead of tamoxifen in certain situations, such as:

  • tamoxifen is causing troubling side effects

  • amoxifen isn’t safe for medical reasons – for example, because there is a history of blood clots

  • the breast cancer has come back and isn’t responding to tamoxifen

  • the breast cancer is metastatic (has spread to other organs in the body)

Aromatase inhibitors work by blocking the enzyme aromatase, which turns the hormones called androgens into small amounts of estrogen in the body. This means that the medicines cause less estrogen to be available to fuel the growth of hormone receptor-positive breast cancer cells.

Aromatase inhibitors are taken daily as a pill, typically for five to 10 years. Doctors often recommend that men who take aromatase inhibitors also take medications called luteinizing hormone-releasing hormone (LHRH) agonists such as Lupron (chemical name: leuprolide) and Zoladex (chemical name: goserelin). These medicines may help the aromatase inhibitors work better by causing the pituitary gland to shut off production of the hormone testosterone by the testicles. LHRH agonists are given as injections once a month or every three months.

Faslodex (chemical name: fulvestrant) is sometimes used in men who have advanced-stage or metastatic breast cancer if other hormonal therapies have stopped working and the cancer shows signs of progression. Faslodex works by blocking and damaging the estrogen receptors in breast cells, so that the cells don’t receive estrogen’s signals to grow and multiply. It is given once a month as an injection.

Timing of hormonal therapy

When treating early-stage breast cancer, hormonal therapy is usually given after other treatments such as surgery, chemotherapy, and radiation therapy are completed. In some cases, men receive hormonal therapy before surgery to shrink the tumor and make it more likely that it can be fully removed.

Hormonal therapy can also be used to treat breast cancer that has recurred or is metastatic. In men with metastatic, hormone receptor-positive breast cancer, hormonal therapy is usually continued as long as it is working to help slow the growth of or shrink tumors. As mentioned above, your doctor may recommend that you switch to a different hormonal therapy if the one you are taking stops working.

Side effects of hormonal therapy in men

Hormonal therapy medicines can cause some distressing side effects. Men have reported experiencing:

  • loss of sexual desire

  • trouble having an erection

  • weight gain

  • hot flashes, which may cause sleep problems

  • mood swings

  • fatigue

  • joint stiffness, joint pain

  • problems with cognitive function

Less common but more serious side effects include heart problems, bone loss, and blood clots.

Be sure to talk with your medical team if the side effects of a hormonal therapy medicine are bothering you. It may be possible to switch to a different dose or a different medication, or to take a selective serotonin reuptake inhibitor (SSRI) medication such as Effexor (chemical name: venlafaxine), which can improve some side effects. Also, it can be helpful to exercise regularly, maintain a healthy weight, eat a balanced diet, and try complementary therapies such as yoga and acupuncture. If you feel that your current medical team isn’t helping you manage the side effects of hormonal therapy, consider getting a second opinion.

Research on hormonal therapy in men

Hormonal therapies haven’t been studied as much in men with breast cancer as they have in women with breast cancer. But these medicines can be very effective in men with hormone receptor-positive disease. For example, research suggests that for men with early-stage, hormone receptor-positive breast cancer, taking tamoxifen after surgery can reduce the chance of recurrence and improve survival.

 

Chemotherapy for male breast cancer

Chemotherapy medicines prevent cancer cells from growing and spreading by destroying the cells or stopping them from dividing. They travel through the bloodstream to kill cancer cells at the original tumor site and throughout the body.

Your doctor may recommend chemotherapy if you are at risk of having cancer spread beyond the breast or if it has already spread. Chemotherapy is not used for male breast cancers with a low risk of spreading to other parts of the body.

Chemotherapy may be recommended if:

  • the cancer is larger than 1 centimeter (half an inch)

  • cancer was found in the underarm lymph nodes

  • the cancer has characteristics that can make it grow quickly, including being HER2-positive, hormone receptor-negative, or high grade

  • the cancer has spread to parts of the body away from the breast area

  • the cancer has recurred or progressed while you have been taking hormonal therapy

If chemotherapy is part of your treatment plan for early-stage breast cancer, it’s usually given after surgery.

If radiation therapy or hormonal therapy are also part of your treatment plan for early-stage breast cancer, they are usually started after chemotherapy. Chemotherapy may be given at the same time as certain targeted therapy medicines. In some cases, chemotherapy may be given before surgery to shrink the tumor.

Chemotherapy medicines used for male breast cancer

There are a number of chemotherapy medicines that are used to treat breast cancer. Men with breast cancer are given the same chemotherapy treatments that are given to women with breast cancer.

In many cases, chemotherapy medicines are given in combination, which means you get two or three different ones at the same time. These combinations are known as chemotherapy regimens. Sometimes chemotherapy medicines are given one at a time, particularly to treat advanced-stage breast cancer.

When recommending chemotherapy medicines, your doctor will consider factors such as the cancer’s stage, hormone receptor status, HER2 status, and whether cancer has spread to the lymph nodes.

Learn more about Chemotherapy.

What to expect during chemotherapy

Chemotherapy medicines can be given in several ways:

  • intravenously (IV), which means they're directly into your bloodstream through an IV or a port

  • a pill or capsule taken by mouth (orally)

  • an injection into a muscle in your arm, leg, or hip, or under skin in the fatty part of your arm, leg, or belly

Learn more about What to Expect During Chemotherapy Treatment

Chemotherapy side effects

Chemotherapy destroys cancer cells because the medicines target rapidly dividing cells. But healthy cells in your blood, mouth, intestinal tract, nose, nails, and hair also divide rapidly. So
chemotherapy affects them, too.

The side effects you may have from chemotherapy depend on the regimen you're on, the amount of medicine you're getting, the length of treatment, and your general health. The
side effects you have may be different from someone else who is on the same regimen.

Learn more about chemotherapy side effects and how to manage them.

 

Targeted therapy for male breast cancer

Targeted therapies are medicines that target specific characteristics of cancer cells, such as a protein that allows the cancer cells to grow quickly or in an abnormal way.

Learn more about Targeted Therapies.

 

Immunotherapy for male breast cancer

Immunotherapy medicines use the power of your body’s immune system to attack cancer cells.

Currently, immunotherapy medicines are used to treat:

  • all stages of triple-negative breast cancer

  • mismatch repair deficient (dMMR) advanced-stage breast cancer that has grown during or after treatment if no other treatment options are available

Learn more about Immunotherapy.

 

Clinical trials and male breast cancer

Clinical trials are research studies in which people agree to try new therapies under careful supervision in order to help doctors identify the best treatments with the fewest side effects. These studies help improve the overall standard of care.

In the past, many clinical trials of breast cancer treatments did not include men. But that is changing. In recent years, more trials have been enrolling both women and men. And in 2020, the U.S. Food and Drug Administration (FDA) issued a guidance recommending that men be included in clinical trials of breast cancer treatments. This is important because more research is needed to understand the best approaches for treating breast cancer in men.

By participating in a clinical trial, you can potentially try a treatment that isn’t otherwise available and that might be beneficial for you. You’ll also be helping researchers find better treatments for others with male breast cancer in the future.

To find out if there’s a clinical trial that’s right for your unique situation:

  • Search for trials on Clinicaltrials.gov.

  • Ask your doctors if they know of any clinical trials that would be right for you.

  • Contact the large cancer centers in your region to find out about their clinical trials.

  • Consider traveling to meet with an oncologist at a major cancer center that has a lot of clinical trials to discuss your options.

If you find a clinical trial that might be suitable for you but you’re not sure if you meet the eligibility criteria, don’t hesitate to reach out to the trial’s research coordinator or principal investigator.

Learn more about Clinical Trials.

— Last updated on January 21, 2022, 3:32 PM