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Importance Of Histology During Gyno Surgery | Incidental Finding Of Ductal Carcinoma In Situ

Feb 27, 2025
March 19, 2026
Medically reviewed by:
Dr Ivan Puah, Medical Director

Read more on gynecomastia, testicular cancer and male breast cancer, and a case study on incidental finding of DCIS found in a patient treated by Dr Ivan Puah.

cancer

Table of Contents

Gynecomastia may indicate health issues such as male breast cancer. Although most cases are benign, around 10% of testicular cancer cases show unexplained breast growth.  A case study identified Ductal Carcinoma In Situ (DCIS) in a patient with gynecomastia, pressing the need to evaluate and biopsy any detected lumps. Dr Puah urges men to seek medical attention for persistent breast changes for early detection and effective management.

Gynecomastia, characterised by enlarged male breast tissue, affects up to 65% of men globally. 

While often benign, it can sometimes signal underlying health concerns.

It is linked to hormonal fluctuations during puberty, ageing and the use of certain medications, chronic illnesses, or underlying tumours. 

Dr Ivan Puah, an MOH-accredited liposuction doctor with vast experience in male chest contouring and gynecomastia surgery, emphasises that “gynecomastia isn’t just a cosmetic issue.” 

Addressing it not only reshapes the chest for a more masculine contour but also provides an opportunity to evaluate excised breast tissue for potential abnormalities.

Gynecomastia and Its Link to various Health Risks

Gynecomastia has been linked to systemic diseases such as liver cirrhosis, hyperthyroidism, kidney failure, as well as cancers of the testicles or breasts. 

Testicular Cancer

While most cases of male breast enlargement (gynecomastia) may stem from harmless hormonal shifts, it’s important to know that it may also signal underlying health concerns such as testicular cancer.

Studies indicate that roughly 10% of testicular cancer cases first present as unexplained breast growth, while about 2% of men with gynecomastia are later found to have testicular tumours [1, 2].

Male Breast Cancer

Male breast cancer is rare. However, a 2024 study suggests that its occurrence is gradually increasing. 

What makes it more concerning is that male breast cancer can share similarities with gynecomastia, especially in how it develops beneath the nipple area.

This overlap can sometimes make early detection challenging, highlighting the importance of proper medical evaluation and diagnosis [3].

Male Breast Cancer Case Studies

Gyno Surgery & the incidental male breast cancer discovery

Male Breast Cancer Case Study #1 (32-Year-Old Male)

A study revealed that gynecomastia tissue in a young patient contained Ductal Carcinoma In Situ (DCIS), a precancerous condition affecting milk duct cells. 

This discovery led to life-saving bilateral mastectomies [4].

Male Breast Cancer Case Study #2 (60-Year-Old Male)

Another patient with a history of prostate cancer underwent gynecomastia surgery, only for histology to detect metastatic prostate cancer cells within the excised tissue. 

The delayed diagnosis resulted in a poor prognosis, requiring aggressive treatment with estrogen analogs [4].

Men diagnosed with breast cancer are often at later stages compared to women, which can delay critical treatment. 

Imaging scans of male breast cancer typically resemble features seen in female breast cancer, such as irregularly shaped masses with jagged edges and sometimes tiny calcium deposits. 

However, these masses can, in some cases, appear deceptively benign on scans, presenting as smooth, oval-shaped lumps [4].

Because of this unpredictability, Dr Puah stresses that any solid lump detected in a man’s breast tissue should be biopsied for an accurate diagnosis.

A Case Of Incidental Finding Of DCIS Found In A Young Gyno Patient Treated By Dr Ivan Puah

Dr Puah saw a man in his early 30s with Grade III gynecomastia, who had been living with this condition for a couple of years. 

Physical examination revealed the classic symptoms of gynecomastia: bilateral swollen breasts with tenderness, the presence of fat tissue, and skin redundancy. I also ordered thorough blood investigations to assess various profiles,

Gynecomastia surgery was performed using a combination of the MDC-Sculpt® Lipo technique to remove excess fat tissue and the 360°GTD® technique to excise the dense glandular tissue.

When the excised tissue was sent for routine histological assessment, the pathology report revealed Ductal Carcinoma In Situ, a non-invasive precancerous condition, within the breast tissue. 

This was an incidental finding, as the patient did not exhibit signs of malignancy, such as nipple retraction or bloody discharge during the clinical examination.

Dr Puah and the medical team immediately coordinated with the respective specialists to ensure he received further investigations and prompt follow-up care.

“This case stands out to me for two reasons. First, it reinforces a key message I share with every patient: Gynecomastia surgery isn’t just about aesthetics; it provides an opportunity to scrutinise tissue that has been growing, sometimes for years, without supervision.
Second, it highlights the importance of meticulous surgical protocols and thorough diagnostics, even in seemingly straightforward procedures,” shares Dr Ivan Puah, medical director of Amaris B. Clinic, with over 20 years of liposuction and body sculpting surgical experience in Singapore. 

Why Early Action Matters

Men struggling with gynecomastia should take this medical condition seriously. Don’t dismiss persistent breast changes as "just fat" or "bad genetics." 

If you notice breast enlargement, tenderness, or lumps, it is important to seek evaluation promptly.

SCARLESS GYNECOMASTIA SURGERY WITH 360°GTD® TECHNIQUE

Aims to achieve a more natural result by addressing the chest from all angles, ensuring a well-contoured and balanced appearance.

Reference