REPLY
Carcinoma of the Male Breast
Ishmael A. Jaiyesimi;
Aman U. Buzdar; and
Merrick A. Ross
1 May 1993 | Volume 118 Issue 9 | Page 749
IN RESPONSE:
We agree with Dr. LeBlond's recommendation of regular follow-up of male patients with breast cancer, which should include self-examination, physical examination, and an annual mammogram of the contralateral breast. We also concur that the emotional trauma associated with prophylactic mastectomy in men may be less than in women. We disagree, however, with the suggestion of an elective "subcutaneous mastectomy" of the uninvolved breast at the time of initial diagnosis. Subcutaneous mastectomy involves an inframammary skin incision through which most breast tissue beneath the overlying skin and nipple-areolar complex is removed. This procedure, however, does not eliminate all breast tissue [1] and therefore does not prevent the development of a new primary breast cancer [2-4]. For a mastectomy to achieve effective prophylaxis, all of the breast tissue must be removed. If an elective prophylactic
mastectomy of the contralateral breast is recommended, a total or simple mastectomy, in which the nipple-areolar complex is removed along with all of the underlying breast tissue, should be the procedure of choice.
The incidence of synchronous or metachronous bilateral breast carcinoma in men, however, is less than 2% [5]. It is, therefore, not advisable to recommend a prophylactic procedure that benefits only a few of the male patients with carcinoma of the breast, especially with little existing evidence that the procedure affects survival. Prophylactic mastectomy, however, may be justified in selected patients who are cancer-phobic or in patients with familial breast cancer.
1. Goldman LD, Goldwyn RM. Some anatomical considerations of subcutaneous mastectomy. Plast Reconstr Surg. 1973; 51:501-5.
2. Goodnight JE Jr, Quagliana JM, Morton DL. Failure of subcutaneous mastectomy to prevent the development of breast cancer. J Surg Oncol. 1984; 26:198-201.[Medline]
3. Eldar S, Maguid MM, Beatty JD. Cancer of the breast after prophylactic subcutaneous mastectomy. Am J Surg. 1984; 148:692-3.
4. Humphrey LJ. Subcutaneous mastectomy is not a prophylaxis against carcinoma of the breast: opinion or knowledge? Am J Surg. 1983; 145:311-2.
5. Scheike O. Male breast cancer. 5. Clinical manifestations in 257 cases in Denmark. Br J Cancer. 1973; 28:552-61.
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