by Sue Friedman, Courtney Floyd and Minas Chrysopoulo, MD
There is a large gap in awareness about inherited gene mutations and how they may affect men. It’s important for men to know about genetic testing, because they are at increased risk for breast, prostate, pancreatic and other cancers if they test positive for a BRCA mutation. Mutations in the genes that are associated with Lynch Syndrome can increase men’s risk for colorectal cancer and possibly other cancers. A FORCE survey found that women who tested positive for an inherited mutation were more likely to tell their female relatives than male relatives. Men are less likely than women to have BRCA testing, even when they are informed of a mutation in the family when a relative tests positive.
Male breast cancer and genetic testing
Many people do not realize that breast cancer isn’t limited to women. Men have breast tissue too and any man can develop breast cancer; men who do are more likely to have a BRCA mutation. For this reason, national guidelines recommend genetic counseling and testing for any man who is diagnosed with breast cancer.
Male breast cancer and mastectomy
Men who are diagnosed with breast cancer often undergo a modified radical mastectomy as part of their treatment. This includes removal of the breast tissue, the nipple-areola complex, and one or more of the axillary lymph nodes. Many male patients also have radiation therapy after surgery, as the disease is often more advanced in men by the time it is diagnosed, primarily due to lack of awareness. Some male breast cancer patients may be candidates for nipple-sparing mastectomy or breast conservation (lumpectomy and radiation), depending on the tumor and staging. However, in most cases, male breast cancer is very close to or involves the nipple-areola complex, which precludes saving it.
Chest or breast reconstruction is an option
Like women who have mastectomy, men can have chest wall deformities and concerns about their appearance following breast cancer surgery. Male breast reconstruction is an option, but unfortunately, very little information is available.
The majority of men who submitted photos to FORCE’s Post-mastectomy Photo Gallery reported that they were never offered breast reconstruction. Federal laws require health plans that pay for mastectomy to cover breast reconstruction for both men and women.
Men who are interested in breast reconstruction have several options to help restore the natural appearance of their chests. The best option depends on the patient’s goals and symmetry needs. Reconstructive options include fat grafting, breast implants, tissue “flaps” that are moved from other parts of the body to the chest, nipple reconstruction, and tattooing. The surgery is usually performed as a “delayed” procedure, when all other treatments are completed.
Fat grafting is the most common method of reconstruction in male breast cancer patients. Fat is liposuctioned from one area of the body, purified, and reinjected in small amounts into the mastectomy site. Some of the injected fat (30-50%) is reabsorbed over time. Patients must therefore be prepared to have more than one fat grafting procedure for the best results.
A small low-profile breast implant, usually placed under the chest muscle, can also be used to reconstruct a male breast. Since the aesthetics of the male breast are usually quite different than the female breast, the best result is often achieved with a custom-made silicone implant.
Patients with advanced local disease in the chest (pectoralis) muscle can require a more extensive type of mastectomy that removes the involved muscle, along with the overlying breast tissue and skin. In these situations, tissue from the back (a latissimus dorsi flap) can be used to reconstruct the chest muscle and breast. In very rare cases, tissue flaps from other parts of the body can also be used, depending on the size of reconstruction required.
Nipple reconstruction can be performed on its own or in conjunction with any other reconstructive procedure. Although nipple reconstruction can be performed in many ways, the bow tie method, which gets its name from the shape of the incision, is the preferred method at PRMA. When performed alone, nipple reconstruction can be completed in the office with a local anesthetic. The nipple and areola are later tattooed for a more natural appearance.
Scar revision can improve the appearance of breast surgery scars after mastectomy or lumpectomy. It can help reduce discomfort from severe scarring or scar tethering to the chest wall. Scar revision can also help improve chest contour defects, particularly when combined with fat grafting.
Various forms of tattooing can be performed, either alone or in conjunction with other reconstructive procedures, including:
- A 2D or 3D nipple-areola tattoo, either alone or in conjunction with nipple reconstruction. 3D tattooing provides the most natural-looking results.
- A decorative tattoo that encompasses the entire surgical site.
Regardless of the type of tattoo, patients should seek out artists who have appropriate licensing and experience in tattooing over surgical sites and scars.
Although breast reconstruction may not be for everyone, it is important for men undergoing breast cancer surgery to know all their options and discuss what option is best for them with their medical team. FORCE has a postmastectomy photo gallery of men and women who have had mastectomy with and without reconstruction. Contact us at [email protected] if you would like to share your photos.
Dr. Minas Chrysopoulo is a board certified plastic surgeon and President of PRMA Plastic Surgery Center for Advanced Breast Reconstruction in San Antonio, TX. Dr Chrysopoulo has dedicated his professional life to advocating for breast cancer patients. He strongly believes that shared decision-making between the physician and patient is crucial in achieving the best outcomes and has built his practice on this philosophy. To empower as many patients as possible to advocate for themselves, Dr Chrysopoulo created the Breast Advocate® App, a free app that assists patients in their breast cancer treatment planning.
Courtney Floyd is the Chief Marketing Officer at PRMA Plastic Surgery. She received her Bachelor’s degree from Texas A&M University in 2010, where she found her interest in marketing and medicine. She has been a part of the PRMA team since July of 2013. She has gained valuable experience through observing breast reconstruction procedures firsthand and working directly with the surgeons and patients at PRMA Plastic Surgery. Because of this experience, she has dedicated her career to creatively reaching and educating others on all their reconstructive options.