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 and reduce the risk of the cancer coming back (recurrence). Treatments for male breast cancer can include surgery, chemotherapy, radiation therapy, hormonal therapy, targeted therapy, and others.
You and your doctor will decide about treatments based on a variety of factors, like the characteristics of the cancer, your overall health, and your personal preferences.
Although treatment approaches and options for men with breast cancer are similar to those for women with breast cancer, there are some differences. Professional medical societies such as the American Society of Clinical Oncology, the National Comprehensive Cancer Network, and the American College of Radiology have created guidelines specifically for diagnosing and treating breast cancer in men.
Surgery for male breast cancer
Most men diagnosed with early-stage breast cancer (stages 0, I, II, or III) have surgery to remove the tumor and 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. Surgery is often one of the first steps of treatment.
Another purpose of surgery is to get more information about the cancer. You’ll receive a pathology report after your surgery that will help you and your doctors decide which additional treatments you’ll receive.
Because 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. Some men who have cancer in one breast may choose 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.
For most men diagnosed with metastatic breast cancer, surgery to remove the primary tumor in the breast isn’t recommended.
Types of surgery for early-stage male breast cancer
These are the most common types of surgery for early-stage breast cancer in men.
Simple (or total) 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. Usually the surgeon also performs a sentinel lymph node dissection, which means they remove one or two (up to about five) lymph nodes under the arm on the side of the tumor to check whether the cancer has spread there.
Modified radical mastectomy
The surgeon removes the nipple, areola, all of the breast tissue, and the skin over the breast. The surgeon also performs an axillary lymph node dissection, which means they remove more than 10 lymph nodes under the arm on the side of the tumor to check whether cancer has spread there.
Lumpectomy (also known as breast-conserving surgery)
The surgeon removes only the breast tumor (the lump) and some of the normal breast tissue that surrounds it. They may also remove some of the lymph nodes under the arm. In men, lumpectomies are less commonly done than mastectomies. (This is because men typically have less breast tissue overall, and the size and location of the tumor may in some cases make mastectomy a better option.) If a man chooses a lumpectomy, his doctors will typically recommend that he gets radiation therapy after the surgery to destroy any cancer cells that may be left behind.
Factors to consider when planning your surgery
Are you a candidate for a nipple-sparing mastectomy?
In a nipple-sparing mastectomy, the surgeon removes the breast tissue but leaves the nipple, areola, and skin of the breast intact. 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.
Could you have an aesthetic flat closure?
If you have a larger or drooping breast, or extra loose skin in the breast area, you may want to ask your surgeon if they can do an aesthetic flat closure. This means they remove extra skin, fat, and other tissue in the breast area during the mastectomy. The remaining tissue is tightened and smoothed out, so you’ll have a smooth, flat chest contour. In many cases, it may help to have a breast surgeon and plastic surgeon working together during your mastectomy to perform an aesthetic flat closure.
What can you do to prevent lymphedema?
If your doctors recommend that you have an axillary or a sentinel lymph node dissection, ask about your options for preventing lymphedema (abnormal swelling in the arm, hand, breast, or torso). The risk of lymphedema is higher with axillary lymph node dissection, but there is a small risk with sentinel lymph node dissection, too. Some people are candidates for a procedure called lymphovenous bypass that is done right after the lymph nodes are removed to help prevent lymphedema.
Breast reconstruction after mastectomy in men
After a mastectomy, some men feel self-conscious about the appearance of their chest (which may be uneven, have a visible scar, and may be missing one or both nipples). Most men have the option of getting reconstruction procedures that help restore the natural shape and appearance of the chest and nipples. In men, reconstruction is usually done sometime after you’ve healed from the mastectomy and completed other treatments, such as radiation therapy and chemotherapy.
The following procedures can be used to reconstruct the chest:
Fat grafting: Fat is removed from another part of your body by liposuction, and then processed and injected in small amounts into the breast area. 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.
Autologous (flap) reconstruction: Tissue transplanted from another place on your body, such as your belly, thighs, or buttocks, is used to form a breast shape — and in some cases to reconstruct the chest muscle, if some of it was removed.
Breast implant reconstruction: A small implant is placed under part or all of the chest muscle (pectoralis) to reconstruct the breast. The type of implant most often used in men is custom-made from solid silicone.
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.
Scar revision: These procedures can improve the look of surgery scars (including by removing excess skin that’s 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 large
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
Some men diagnosed with metastatic breast cancer may have radiation therapy to relieve symptoms or help avoid complications in specific areas where cancer has spread, such as the bones.
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. Chemo is usually given after surgery. In some cases, it may be given before surgery to shrink the tumor.
Chemotherapy may be recommended, usually after surgery, if:
the tumor was large
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
In men with hormone receptor-positive, HER2-negative breast cancer, the Oncotype DX Breast Recurrence Score Test may be used to help decide if chemotherapy would be beneficial.
Chemotherapy is not used for male breast cancers with a low risk of spreading to other parts of the body.
Targeted therapy for male breast cancer
Targeted therapies are medicines that target cancer cells with specific characteristics, such as a protein that allows the cancer cells to grow quickly or in an abnormal way.
Certain targeted therapy medicines are sometimes used to treat breast cancer in men. For example, the CDK4/6 inhibitor medicines Verzenio (chemical name: abemaciclib) or Kisqali (chemical name: ribociclib) may be used in combination with certain hormonal therapy medicines to treat men with early-stage, hormone receptor-positive, HER-2 negative breast cancer that has a high risk of recurrence.
Other targeted therapy medicines target the HER2 or PIK3CA genes, PD-L1 proteins, or mutations in the BRCA1 or BRCA2 genes to treat metastatic breast cancer in men.
Immunotherapy for male breast cancer
Immunotherapy medicines use your body’s immune system to attack cancer cells. In rare cases, they can be used to treat male breast cancer. For example, immunotherapy medicines can be used to treat triple-negative breast cancer in men.
Hormonal therapy for male breast cancer
The vast majority of male breast cancers of any stage are hormone receptor-positive. This means that the cancer cells receive signals from estrogen, progesterone, or both, that cause them to grow and divide.
If you’ve been diagnosed with hormone receptor-positive breast cancer, your doctors are likely to recommend that you take hormonal therapy for five years or more.
Hormonal therapy helps treat hormone receptor-positive breast cancer by lowering the amounts of certain hormones the body produces or blocking their effects on cancer cells. This helps reduce the chance of recurrence. The hormonal therapy medicines used to treat hormone receptor-positive breast cancer in men are:
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
luteinizing hormone-releasing hormone (LHRH) agonists, such as Lupron (chemical name: leuprolide) and Zoladex (chemical name: goserelin), are often taken with aromatase inhibitors
The following hormonal therapy medicines are sometimes used to treat male breast cancer that is metastatic.
Faslodex (chemical name: fulvestrant): sometimes used if other hormonal therapies have stopped working and the cancer shows signs of progression
Orserdu (chemical name: elacestrant): may be prescribed for men diagnosed with estrogen receptor-positive, HER2-negative breast cancer that has an ESR1 mutation and has spread to other areas of the body
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 to be fully removed.
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. If the hormonal therapy you are taking stops working, your doctor may recommend you switch to a different one.
Side effects of hormonal therapy in men
Hormonal therapy medicines can cause strong side effects. These include:
loss of sexual desire
trouble having an erection
hot flashes, which may cause sleep problems
joint pain and stiffness
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 to improve some side effects. It can also help 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.
Clinical trials and male breast cancer
Clinical trials are research studies in which people agree to try new therapies under careful supervision so doctors can identify the best treatments with the fewest side effects.
By participating in a clinical trial, you can get access to the newest treatments that may not be otherwise available. Also, since breast cancer in men is rare, there’s less data on the best ways to treat it. When you enroll in a clinical trial, you’ll be helping researchers find better treatments for other men with breast cancer in the future.
To find out if there’s a clinical trial that’s right for you:
Search for trials on Clinicaltrials.gov.
Ask your doctors if they know of any clinical trials that would be right for you.
Contact large cancer centers in your region to find out about their clinical trials.
Contact a nonprofit that helps people with breast cancer find clinical trials, such as BreastcancerTrials.org.
Finding a medical team for male breast cancer treatment
Because breast cancer in men is rare, many doctors have little or no experience treating it. Men who have had breast cancer have reported, and some research has shown, that men are not always offered appropriate treatment options. To get the best care, it’s a good idea to find a treatment team that is knowledgeable about breast cancer in men and familiar with treatment guidelines and the latest research.
“Ideally, you should get your care at an academic medical center, from a multidisciplinary team that is experienced and specialized in treating male breast cancer,” says Elaine Walsh, MD, PhD, a medical oncologist at MedStar Georgetown University Hospital in Washington, D.C.
If this isn’t possible, Walsh recommends getting a second opinion from 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.
Patient advocacy groups such as Male Breast Cancer Happens and the Male Breast Cancer Global Alliance can help connect you with doctors who specialize in treating male breast cancer.
