Radiography of the male breast in gynecomastia

In order to investigate the role of imaging methods in the evaluation of the male breast we reviewed the mammograms and ultrasonograms (US) performed in 40 men with breast enlargement or pain. The patients, whose breasts were examined by either mammography (n = 7) or US (n = 1) or both (n = 32), ranged in age from 14 to 83 years. The final diagnoses were gynecomastia in 35 patients, lipomas in one, abscess or sequelae to abscess in 2, and normal in 2. In gynecomastia the subareolar density was of varying shape and size or showed a diffuse pattern of heterogeneous density occupying the whole breast on mammography, and a retromammillar hypoechoic focus, a diffuse heterogenous area, or a combination of these was observed at US. Eleven breasts and one axillary lymph node were examined by US-guided fine-needle aspiration biopsy (FNAB), which was diagnostic in all cases. Mammography is recommended for the evaluation of the male breast if the differential diagnosis between gynecomastia and fatty enlargement is not clinically evident, and in all cases of unilateral breast symptoms. US is a complementary method to mammography and is also useful to provide guidance for FNAB.