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Referral criteria from primary care - male breast enlargement

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • GPs - When and Where to Refer (1)

    • Abnormal endocrine (hormonal) blood results - note if a marginally raised prolactin then repeat before considering referral
      • Refer to Medical Endocrinology clinic

    • Abnormal sHCG or alpha fetoprotein blood results or abnormal finding on testicular USS
      • Refer to Urology Clinic urgently

    • Referral directly to the Breast Unit
      • In the presence of the following clinical scenarios, a referral directly to the local breast unit may be considered.
        • 1. Clinical suspicion of malignancy
          • >50 year old man with unilateral firm sub-areolar mass with or without nipple discharge or with associated skin change
          • Bloody nipple discharge
          • Unilateral ulceration of the nipple
          • Urgent referral is appropriate
        • 2. Unilateral lump with
          • No obvious physiological or drug cause
          • Increased risk - family history
          • Genetic conditions e.g. Klinfelter's Syndrome
          • Urgent referral is appropriate
        • 3. Persistent painful gynaecomastia (>6 months) with normal blood tests


  • (1) Association of Breast Surgery Summary Statement (June 2019). Investigation and management of gynaecomastia in primary and secondary care.

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