A breast lump in a man: what to check and when to seek care

October’s breast-health messaging can make some men wonder whether a change on their own chest matters. It does. Male breast cancer is uncommon, while benign causes are far more frequent, but rarity is not a reason to ignore a persistent or suspicious change.

Not every lump is the same

The word “lump” can describe several different findings: a disc of glandular tissue behind the nipple, fatty tissue across the chest, a skin cyst, inflammation, an injury-related change or a discrete mass. You cannot reliably separate these possibilities from appearance alone.

Gynaecomastia is benign growth of glandular breast tissue. It often feels like a rubbery or firm area centred directly beneath the nipple and may be tender, especially when it develops. It may affect one or both sides. Increased chest fat without glandular enlargement is sometimes called pseudogynaecomastia. Neither is the same as breast cancer, and gynaecomastia is not considered a premalignant condition.

Changes that should not be ignored

Arrange a medical assessment for any new, unexplained or persistent breast change. Seek it promptly when you notice:

• A hard, irregular or fixed lump, particularly if it is not centred under the nipple
• A nipple that newly pulls inward, changes direction, bleeds or produces discharge
• Dimpling, ulceration, persistent scaling, redness or swelling of the breast skin
• A lump or swelling in the armpit or near the collarbone
• Rapid enlargement, significant pain, fever or redness that is spreading

These findings do not automatically mean cancer. They are reasons to move from self-observation to a clinical examination. Sudden painful swelling with fever or feeling acutely unwell may indicate infection and needs same-day care.

Why gynaecomastia can develop

Male breast tissue responds to the balance and action of androgens and oestrogens. Gynaecomastia can occur during puberty and with ageing, and it may follow a change in this hormonal balance. Sometimes no single cause is found.

A careful history matters because prescribed medicines, non-prescription products, anabolic steroids, hormones, alcohol and recreational substances can contribute. Liver, kidney, thyroid or testicular conditions may also be relevant. Obesity can increase chest fat and is associated with hormonal changes, but it should not be used as an automatic explanation for a discrete lump.

Who may carry a higher breast-cancer risk?

Breast cancer can occur in men of any age, although risk increases with age. Factors that may raise risk include a strong family history of breast cancer, an inherited pathogenic variant such as BRCA2, previous radiation to the chest, Klinefelter syndrome, liver disease, obesity and certain testicular conditions.

A family history is not limited to female relatives. Tell your doctor about breast, ovarian, pancreatic and prostate cancers on both sides of the family, as well as any known genetic test result. This may affect whether genetic counselling or a specialist opinion is appropriate.

What a proper assessment may involve

The first step is usually a focused consultation and examination—not a pre-selected scan or treatment package. Dr Luhard may ask when the change started, whether it is painful or growing, and about puberty, sexual function, fertility, general health, family history and previous cancer treatment. Bring a complete list of medicines, injections, supplements and gym or performance products.

The examination helps distinguish glandular tissue from fat and looks for features that require further investigation. The chest, nipples, lymph-node areas and, where clinically appropriate, the thyroid, abdomen or testes may be assessed.

Tests are chosen according to the findings. Selected hormone, liver, kidney or thyroid blood tests may be useful when gynaecomastia has no clear explanation. Imaging is not automatically required when the examination is clearly typical of gynaecomastia. For an indeterminate lump or suspicious findings, diagnostic mammography and/or ultrasound may be appropriate; a suspicious lesion generally needs tissue sampling rather than repeated reassurance.

What not to do while you wait

• Do not rely on repeated photographs or internet comparisons to decide that a lump is harmless.
• Do not repeatedly squeeze the nipple to check for discharge; note what occurred and tell the clinician.
• Do not start an “oestrogen blocker” or another hormone product without a diagnosis and medical oversight.
• Do not stop prescribed medicine abruptly. Ask whether timing, substitution or supervised review is appropriate.

One male-health question, one clear care pathway

The connected brands have distinct roles. MaleHealth is the male-focused information and private enquiry gateway. Dr Luhard is the author and consulting doctor. Clinical consultations and treatment take place through Medify, the patient-care practice in Waterkloof. If imaging, biopsy, genetic counselling or specialist breast care is indicated, the next step is referral—not an attempt to keep every part of care inside one brand.

This structure is intended to make the route simpler: start with the male-specific concern, receive an appropriate medical assessment and move to the right service or specialist when needed.

How to prepare for the consultation

• Note when you first noticed the change and whether it is growing, painful or intermittent.
• Bring your medication, hormone, supplement and performance-product list.
• Write down relevant cancers in close relatives and the age at which they were diagnosed.
• Mention nipple discharge, skin change, weight change, testicular symptoms or other new symptoms.
• Bring previous imaging or blood-test results if you have them.

References and further reading

1. US National Cancer Institute: Male Breast Cancer
2. American College of Radiology: Evaluation of the Symptomatic Male Breast
3. European Academy of Andrology: Clinical practice guideline on gynaecomastia evaluation and management
4. Cancer Association of South Africa: Men and Breast Cancer