Management of Male Breast Symptoms

Following guidance published by the Association of Breast Surgeons and endorsed by the Royal College of GPs we have clarified the criteria for referral of male patients to the Breast Unit at the Royal Surrey NHS Foundation Trust.
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These new guidelines reflect the primary role of the Breast unit to investigate and treat patients with possible male breast cancer. The majority of male referrals have gynaecomastia and for most of these patients, investigations and management can take place in primary care.

Following this some patients will continue to require referral to the endocrinologists, urologists or the breast unit.
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For those patients with persistent symptoms of gynaecomastia there remains a role for hormonal treatment, which is prescribed off-licence. The role of surgery for gynaecomastia in NHS practice locally is extremely limited as outlined by the Surrey Heartlands IFR policy.

Criteria for Adult Male referral to Royal Surrey Breast Unit
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1. Unilateral lump AND
+ Patient >50 y/o 
+ Genetic predisposition 
+ Increased risk (ie FHx, previous radiotherapy)
+ No obvious physiological or drug cause* 
2.Nipple Changes
+ Discharge                    
+ Unilateral Nipple Ulceration       
3. Persistent Painful Gynaecomastia
+ >6/12 AND no reversible causes*
* Please ensure 

• Normal 9am Testosterone/ Thyroid FT/ LFTs/ β-HCG/ αFP
• No common causative drugs

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Information to support the management of gynaecomastia in Primary Care 

• ABS/RCGP Infographic on Management and Investigations (pdf)
• Information Leaflet on Gynaecomastia  (pdf)
• Referral form 
• Link to BMJ review Paper on Gynaecomastia (includes table listing commonly associated drugs)
• Association of Breast Surgeons Guidelines 2021 (pdf)
• Common Drug causes of Gynaecomastia 
• Surrey Heartlands IFR policy ​​

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ABS and RCGP endorsed Gynaecomastia Infographic