Medical Oncologist
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Risk-reducing mastectomy in men with a BRCA mutation
Men with a BRCA change, especially BRCA2, have a higher chance of breast cancer than other men, but it stays low compared with women. Preventive mastectomy is therefore rarely advised. This page explains the usual care plan, chest signs to report, prostate and other checks, and what your result means for relatives.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- Should men with a BRCA mutation consider a risk-reducing mastectomy?
- What care usually looks like for male carriers
- Chest changes men should report
- The vocabulary, in plain language
- Honest realities for men with BRCA
- Situations where surgery may be discussed
- What your result means for relatives
- What people assume about men and BRCA
- Common questions about BRCA and preventive mastectomy in men
The short answer
Should men with a BRCA mutation consider a risk-reducing mastectomy?
Men have a small amount of breast tissue behind the nipple, and breast cancer can develop there, although it is far less common than in women. Men who carry a harmful change in the BRCA2 gene, and to a lesser extent BRCA1 or PALB2, have a higher chance of breast cancer than other men. Even so, that chance remains low compared with the risk faced by women carrying the same gene change. For this reason, risk-reducing mastectomy is very rarely recommended for men with a BRCA mutation. Most guidelines instead advise breast awareness, which means knowing how your chest normally looks and feels and reporting changes early, along with a yearly chest examination by a doctor from an age your team suggests. Some centres may offer imaging for men with enlarged breast tissue or a strong family history of male breast cancer. For BRCA carriers, the bigger health priorities are often other cancers linked to the gene. BRCA2 in particular raises the risk of prostate cancer, which can be more aggressive, and is also linked with pancreatic cancer and melanoma. Planned screening for these cancers is usually more valuable than breast surgery. A mastectomy may still be discussed in unusual situations, such as enlarged breast tissue that causes distress, a previous breast cancer, or very strong family history, but it is an individual decision made with a specialist team.
Male breast cancer risk rises but stays low
BRCA2 carriers have a higher risk than other men, yet most will never develop breast cancer.
Surgery is rarely advised
Breast awareness and regular chest checks are the usual approach.
Other cancers need attention
Prostate, pancreatic and skin cancer checks are often more important for male carriers.
This page gives general information only. A genetics team can explain what your gene change means for you.A typical plan
What care usually looks like for male carriers
Plans vary with the gene involved and your family history, but these parts are common.
Breast awareness
Look at and feel your chest regularly, including around and behind the nipple, and report any new lump or change without delay.
Clinical chest checks
A doctor may examine your chest once a year from an age your team recommends, often from the mid-thirties.
Routine male mammograms are not generally advised.Prostate checks
BRCA2 carriers are often advised to start prostate cancer screening earlier than other men, with a PSA blood test.
Other checks
Depending on family history, extra checks may be discussed.
May include
- Skin checks for melanoma
- Pancreatic screening in selected families
- Testing for relatives
Know the signs
Chest changes men should report
Change
Why it matters
A firm, painless lump behind or near the nipple
The most common sign of breast cancer in men
Nipple turning inwards
Can be a sign of a lump pulling on the nipple
Discharge or bleeding from the nipple
Should always be checked in men
A sore, rash or crusting on the nipple
May need a closer look if it does not heal
A swelling in the armpit
Could be a lymph node that needs checking
Not sure whether this applies to you?
Ask an oncologistWords you may hear
The vocabulary, in plain language
- Male breast cancer
- Cancer that starts in the small amount of breast tissue men have behind the nipple.
- Gynaecomastia
- Enlargement of male breast tissue, which is common and usually not cancer.
- PSA test
- A blood test that can help screen for prostate cancer.
- Breast awareness
- Knowing how your chest normally looks and feels so you notice changes.
- Cascade testing
- Offering genetic testing to relatives after a gene change is found in the family.
- Carrier
- A person who has inherited a gene change, whether or not they develop cancer.
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Being straight with you
Honest realities for men with BRCA
Men carrying a BRCA change face different questions from women, and information is sometimes harder to find.
Evidence for men is more limited
Male breast cancer is uncommon, so studies are smaller and guidelines rely partly on expert opinion.
Men often notice changes late
Many men do not expect breast cancer, so lumps are sometimes ignored for months.
Surgery has downsides too
A mastectomy leaves scars and numbness, and complications can occur, for a benefit that is usually small.
Your result matters for your family
Daughters, sisters and sons may carry the same change and could benefit from testing.
What this page cannot tell you
It cannot set your screening plan. A genetics or high-risk clinic can tailor it to your gene and family.
Exceptions
Situations where surgery may be discussed
Although uncommon, a few situations may lead a specialist team to talk about removing breast tissue in a male carrier.
Previous breast cancer on one side
A man who has already had breast cancer may discuss whether to remove tissue on the other side.
Enlarged breast tissue
Gynaecomastia that is large, painful or distressing may be removed, which also lowers the small cancer risk.
Very strong family history of male breast cancer
Several affected male relatives may prompt a closer look at options.
Difficulty examining the chest
If the chest is hard to assess, imaging or surgery may be considered case by case.
Your family
What your result means for relatives
Men are often tested after a female relative is diagnosed, but a man's result is just as important for the family.
Children have a one in two chance
Each son and daughter has an equal chance of inheriting the gene change from you.
Daughters face higher breast risk
Daughters who inherit the change may need screening and prevention advice as young adults.
Sons need awareness too
Sons who inherit it should know about prostate and breast checks as they grow older.
Sharing the news
A genetic counsellor can help you plan how and when to tell relatives, including a letter they can take to their own doctor.
Commonly believed
What people assume about men and BRCA
Men cannot get breast cancer.
Men have breast tissue and can develop breast cancer, especially BRCA2 carriers.
BRCA only matters for women.
Male carriers face higher risks of several cancers and can pass the change to children.
Male carriers should have their breasts removed like women.
Surgery is rarely advised for men because their breast risk stays low.
Genes only pass through the mother's side.
Fathers pass BRCA changes to children just as often as mothers.
Questions we are asked
Common questions about BRCA and preventive mastectomy in men
How high is breast cancer risk for men with BRCA2?
It is clearly higher than for men in general, but still much lower than for women with the same gene change. Most male BRCA2 carriers never develop breast cancer. BRCA1 raises male breast risk less. A genetics team can explain the figures in plain terms for your gene and family history.
Do men with BRCA need mammograms?
Routine mammograms are not usually recommended for male carriers. Instead, breast awareness and a yearly chest examination by a doctor are commonly advised. Imaging may be used if you notice a change or in selected situations, such as enlarged breast tissue or a strong family history.
Should I start prostate cancer screening early?
Men with BRCA2 changes are often advised to begin prostate screening earlier than other men, typically with a PSA blood test from an age such as the early forties, though advice varies. BRCA1 carriers may also be offered it. Discuss the best starting age with a genetics or urology team.
Can I pass the gene change to my children?
Yes. Each of your children has a one in two chance of inheriting it, whether they are sons or daughters. Testing for children is usually offered once they are adults and can decide for themselves, because it rarely changes care in childhood.
What does breast cancer in men usually feel like?
It most often appears as a firm, painless lump just behind or near the nipple. There may also be nipple changes, discharge, a sore that does not heal or swelling in the armpit. Most chest lumps in men are not cancer, but any new lump should be checked promptly.
Is enlarged breast tissue a sign of cancer?
Usually not. Gynaecomastia is common and is often linked with hormones, weight, some medicines or liver problems. It tends to feel rubbery and sit evenly under the nipple, sometimes on both sides. A hard, uneven lump on one side is more concerning and should be examined.
Is surgery ever the right choice for a man?
In rare cases, yes. A man who has had breast cancer on one side, has distressing enlarged breast tissue, or has a very strong family history of male breast cancer may discuss surgery with a specialist. It is an individual decision weighing a small benefit against surgical effects.
Where should a male carrier be followed up?
A genetics service or high-risk clinic can coordinate your plan, including chest checks, prostate screening and advice for relatives. Your family doctor, urologist and dermatologist may all play a part. Keep a written copy of your gene result to share with every doctor you see.
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Talk to our team
Speak to a breast cancer specialist
Call the helpline or leave your details, and someone will help you arrange a consultation at the CION centre nearest you. One helpline serves every CION centre.
Call 1800 202 8726
Helpline open 24/7
Sources
- National Cancer Institute — BRCA gene changes: cancer risk and genetic testing
- American Cancer Society — Breast cancer in men
- Cancer Research UK — Male breast cancer risks and causes
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.