Episode 5 – Men Have Breast Issues Too with patient John Wejesooriya

John Wejesooriya:

It’s helped my self esteem a lot. I’m a lot more confident in my body.

Wendy Squires:

My name is Wendy Squires. I’ve been a journalist for more than 30 years, specializing in health issues, which is why I have the great honor of introducing highly respected breast doctor and surgeon, Dr. Nicole Yap. She’s an expert in oncoplastic, which involves removing cancers with pleasing aesthetic results for patients. Training in both plastic and general surgery, Dr. Yap’s breast techniques were refined whilst working at the European Institute of Oncology in Milan, at The Royal College of Surgeons in London, and working with world renowned experts in Paris and Leon. Amongst her many accolades, Dr. Yap is a former deputy chair of the Royal Australasian College of Surgeons, and it’s representative on the Cancer Council Victoria, Medical & Scientific Committee. She’s also a Pink Hope expert advisor, and vice president of the Medico-Legal Society of Victoria.

Wendy Squires:

Dr. Yap is currently finalizing plans to open a one-stop breast care center in Melbourne, the first of its kind, which will include a multidisciplinary team of professionals to ensure any issues involving breasts can be catered to by relevant experts in the one place. Dr. Yap leads a team which includes a breast care nurse, pathologist, radiologist, medical oncologist, and radiation oncologist, to assist patients with their respective individual cancer management plans. However, her planned groundbreaking clinic will not just be for cancer patients, but for anyone with breast issues, whether they be malignant, benign, or aesthetic, enabling treatments to be combined or treated in isolation.

Wendy Squires:

Today, Dr. Yap and I have in one of her patients, John Wejesooriya. We’re talking about a very important topic, one I think that’s mainly overlooked in the breast cancer conversations going at the moment, and that is the issue of men. Men do and will get breast cancer.

Dr Nicole Yap:

Well, men do have issues with their breast per se, not just breast cancer, but also benign diseases of the breasts. I think that’s why a lot of men don’t present early, because not only do we think they don’t get it, but they think as well…

Wendy Squires:

That they don’t get it. I know it’s a terrible circumstance. Can you give us some sort of statistics around the percentages of men?

Dr Nicole Yap:

Yes. Overall, in all breast cancers, men actually feature only about up to 1% of breast cancers. The statistics for America, which are quite current, is that they expect this year, that there’ll be 2,600 men that will be diagnosed. Unfortunately, because they present early, over 500 of those men will pass from the disease.

Wendy Squires:

Because they’re simply just not recognizing.

Dr Nicole Yap:

Correct.

Wendy Squires:

Are men supposed to check their breasts, like women are supposed to check their breasts for cancers?

Dr Nicole Yap:

I think men should check everything just like women should check everything. It’s a lot easier for a man to check their breasts, because there’s very little breast tissue there. If they see anything that’s not similar on either side, that’s a warning sign. A unilateral, that is one breast that’s enlarging, a hard lump for example, any nipple inversion or discharge, is always an issue… Especially nipple discharge.

Wendy Squires:

So, what should we look out for with nipple discharge? What should men be aware of?

Dr Nicole Yap:

Any nipple discharge in general from a male is bad news.

Wendy Squires:

Well luckily in John’s case, you didn’t have a cancer, but you went through what a lot of men go through, and that’s being unhappy with the aesthetic appearance of your breasts. Can you give us a little bit of a background on how you ended up seeing Dr.Yap?

John Wejesooriya:

I ended up seeing Dr. Yap after I … In around 2018, I went to my GP because I was rather overweight at the time. I asked him just some advisory before I attempt to lose some weight. About nine months went by, and in that period I lost almost 30 kilos.

Wendy Squires:

30 kilos? Congratulations.

John Wejesooriya:

Thank you. That’s when I noticed the breasts were still around. They were still quite prominent if not more prominent than earlier, because the rest of my frame is skinny, and they’re still sticking out there. So, then I went back to my GP and asked what can be done, and he referred me to Dr. Nicole Yap.

Wendy Squires:

Dr Yap, first off, can you explain why John’s breasts were still… After he’d lost all that body weight, is it somewhere… Everyone says you first lose it off your boobs, but I haven’t found that to be the case either when I’ve lost weight.

Dr Nicole Yap:

Yes. It does depend on the individual. If you’re going to lose weight, you’re going to lose it from certain parts of your body, and that’s a more or less an individual experience. But with men, it does tend to happen that they do seem to have… Once they’ve got the fat pad happening around their breast, it seems to stay there. The other thing too is that with fattier situation, actual adipose tissue, which is fat tissue, can make estrogen. Estrogen can make breast tissue. So, you will find that people who are obese tend to make more breast tissue, and that’s the case with gynecomastia, which is the terminology for an enlarged breast, specifically in men.

Dr Nicole Yap:

In John’s situation, he had a little bit more breast tissue as well as fatty tissue, and that was of course made more prominent once he lost the rest of the weight from around that area. He also… His skin was stretched in that area from having excessive weight around there in the past, and that hadn’t retracted. So, that makes for an even larger appearing breast.

Wendy Squires:

How awful for you to have gone through all of that hard work to lose the weight, and then still not being happy with your appearance. I think that must have been incredibly frustrating for you.

John Wejesooriya:

Yes it was. It certainly was.

Wendy Squires:

Dr. Yap, what did you advise, and what did you end up doing with John?

Dr Nicole Yap:

Well, he’d really done the majority of the hard work, which was losing the weight, so there wasn’t a lot more we could do by surgery. Also, the thing is, as everyone else would like, John didn’t want too much scarring. He had slightly asymmetrical, that means not symmetrical, breasts. One side was a bit smaller than the other. The larger breast, I was very concerned that we wouldn’t get away with hiding the incision around the areola complex. You can do that. You can incise through there, remove excessive tissue, leaving a small mound under the nipple areola, because that is what all men look like. If you take it all, you look slightly odd. So, we had to leave a little bit there, and still remove excess skin.

Wendy Squires:

Of course.

Dr Nicole Yap:

So, the larger the breast is, the more excess skin you have to remove, and then that becomes constituted down into the areola that was remaining. As with women with large breasts, the areola can be slightly bigger too… True, it’s been stretched. That had to come down as well. There was a few issues I was concerned about on the larger side. I wasn’t too concerned about the smallest side, because I knew we would achieve a good result there. But I mean, fortunately, even though I warned him that we might have to do serial procedures, meaning a couple to maintain a nice scar, we only needed to do one.

John Wejesooriya:

Yes we did.

Wendy Squires:

Oh, that’s good news, isn’t it? Because is it true that it’s harder in men, or around the areola, to hide the scars?

Dr Nicole Yap:

Well, if you have too much skin, you might need to do a transverse, that’s a horizontal scar that’s below the nipple areola. That’s obvious if you go to wear nothing on top. If you hit the beach or something like that, you can see a scar. Most people won’t realize that’s a scar from a breast reduction because that’s not well-known, but it would be nicer not to have such an obvious scar.

Wendy Squires:

Luckily you didn’t get one.

John Wejesooriya:

No, I don’t have a scar.

Wendy Squires:

So John, how do you feel about it now? One, I think it’s fantastic that you’re here, because this is going to help a lot of other men, I believe, who were in the same situation as you. What difference does it make to you?

John Wejesooriya:

A lot better self esteem. Previously, like when I enjoyed swimming, I religiously wore a t-shirt when I was swimming. Everyone asked why on earth would you do that, and I just say… I make up the biggest lie saying, oh, just doing it for some training. It was mainly to hide my shame.

John Wejesooriya:

It’s helped my self esteem a lot. I’m a lot more confident in my body.

Wendy Squires:

As you’re going through the process, recovery time and everything, was it a painful procedure?

John Wejesooriya:

No. Not at all painful. In terms of pain, not very much at all.

Wendy Squires:

What would you advise any other bloke that’s in the same circumstance as you were?

John Wejesooriya:

It’s going to hurt your pride a bit asking about it, but it’s worth it. Don’t hold off on it. If you’re concerned about it, or it’s hurting your self esteem, because a lot of men don’t like to admit something’s wrong with them, it doesn’t hurt to check.

Wendy Squires:

I think that’s very wise words indeed.

Wendy Squires:

What would you say to any man who’s out there?

Dr Nicole Yap:

Oh well, I say to any man or woman, you have to present early, because you don’t know if this is just a benign problem or not. That’s why I’d like people to present, especially if they’ve got one breast larger than the other.

Dr Nicole Yap:

In gynecomastia benign disease, it’s not just obesity that may produce this problem, but it’s also certain drugs, anabolic steroids, some thyroid disease that we need to be aware of, some testicular cancers, and some brain tumors such as tumor of the pituitary gland, can cause this problem, and adrenal glands as well. When you see someone like this, you can’t just say, oh well, it’s just part of your physiological state. You have to test for all these things, and it might be a good idea to present because maybe you have a testicular tumor, and that puts a different light on things. So, I think that’s why it’s really important if things aren’t just right for you.

Dr Nicole Yap:

But at the end of the day, this sort of thing can occur in plain simple physiology, especially with just after puberty, men can develop this problem, and also in older age. Both of these are due to an imbalance of the estrogen and the testosterone. But even if you think that’s the case, it’s good just to get checked. If that’s all it is, and it settles down, great.

Wendy Squires:

Yeah, nothing lost. I think it goes back to that vigilance, and understanding your own intuition, and acknowledging it, and presenting early if you’ve got any issues with your breasts. Thank you for coming in John.

John Wejesooriya:

My pleasure.

Wendy Squires:

It was lovely to meet you.