Most male breast lumps are gynaecomastia (subareolar, symmetric, fan- or flame-shaped); an eccentric, irregular mass is cancer until proven otherwise — mammography and ultrasound together separate them.
Orient first
- Gynaecomastia patterns: nodular (early), dendritic (chronic), diffuse glandular.
- Male breast cancer is eccentric to the nipple, irregular, and may cause nipple retraction or skin changes.
- Pseudogynaecomastia is fat only.
Acquire the study
- Bilateral CC and MLO views.
The manoeuvre
- Subareolar density centred on the nipple: flame-shaped (nodular) or dendritic.
- Eccentric mass: margins, spiculation, microcalcification.
- Symmetry with the other side; nipple retraction.
What confirms it
- Gynaecomastia: subareolar, nipple-centred tissue; cancer: eccentric suspicious mass with histology.
What licenses you to exclude it
- Typical gynaecomastia on imaging needs no biopsy (BI-RADS 2).
The classic misread
- Calling asymmetric gynaecomastia a mass — it remains centred on the nipple.