The mammographic visualization of male breast tissue may be unsatisfactory due to the high contrast between high-density muscle and low-density breast tissue. This article details a modified positioning technique to alleviate this discrepancy.
is the Director of Breast Imaging and Radiology,
are Diagnostic Radiologists and
is a Resident at Mount Sinai Medical Center, Comprehensive Breast
Center, Miami Beach, FL.
Mammography of the male breast can be technically challenging,
particularly in young patients with large muscle mass. Compression
may be inadequate because the pectoralis muscle is relatively large
compared with the breast tissue, and, therefore, the visualization
of the breast tissue is unsatisfactory due to the high contrast
between the high-density muscle and low-density breast tissue. To
alleviate this problem, we applied a modified positioning technique
by displacing the pectoralis muscle posteriorly and pulling the
breast tissue anteriorly, similar to the technique of Eklund as
used for imaging of the augmented breast.
Materials and methods
In addition to the routine views, we performed modified
craniocaudal and mediolateral oblique pectoralis displaced views on
10 consecutive male patients referred for mammography. The
pectoralis muscle is pushed posteriorly against the chest wall
while the subcutaneous breast tissue is gently pulled anteriorly
and held in place with the compression device (Figure 1).
The procedure greatly improved the visibility of the breast
tissue compared with the standard compression views by showing more
details on the images and more breast tissue (Figures 1 and 2) in
Mammography of the male breast is an infrequent examination,
accounting for <1% of mammograms.
Adequate technique for mammographic positioning and visualization
is challenging for the mammographers. The standard mediolateral
oblique and craniocaudal views are routinely suggested for use.
The caudocranial (reverse craniocaudal) view can be used as a
supplementary projection to maximize the amount of tissue
visualized in men who do not have a protuberant abdomen.
However, breast tissue in men may be difficult to visualize
because of the brightness of the pectoralis muscle. In women, it is
of utmost importance to include a wide strip of the pectoralis
muscle to maximize the amount of posterior breast tissue on the
Suboptimal imaging of male breast tissue may occur by satisfying
this requirement. Supplemental views of the breast without the
muscle may be needed to achieve more uniform compression of the
breast tissue. The greatest improvement in quality was achieved on
the mediolateral oblique view, as this is the view where the
greatest amount of muscle is included (Figure 2).
Most of the cases of gynecomastia and other pathologic
conditions, such as carcinoma, lipoma, and abscess, occur in the
area of the nipple and areola in the male breast.
The modified pectoralis displaced view can be performed with a
small spot compression paddle at the usual area of interest at the
subareolar region. Generally, the area is small enough to be
included under the spot paddle.
If the pectoralis muscle is properly penetrated, the small male
breast tissue may be inadequately compressed and overexposed.
Modified pectoralis displaced positioning for men is proposed,
similar to the implant displaced views for women with breast
augmentation. The breast tissue is pulled over and in front of the
pectoralis muscle, which results in improved visualization and
compression of the breast tissue. All four images (bilateral,
mediolateral, oblique, and craniocaudal views) can be supplemented
by pectoralis muscle displaced views or individually as needed on a
case-by-case basis. This technique may be applicable to women with
small breasts and large pectoralis muscles or women with large
Mammographic examination of male breasts can be difficult,
especially since compression may be inadequate. Pectoralis
displaced views should be utilized when breast tissue is
inadequately visualized on conventional mammography views. This
technique is particularly helpful in muscular men.
The authors thank Maria De Leon and Mayren Lama-Viamontes for
their invaluable assistance in performing the images for this