A case of a man with the recent onset of painful bilateral firm gynecomastia is reported. Mammography confirmed increased breast density. Biopsy characterized both masses as metastases of a small-cell lung tumor.This case highlights the atypical presentation and complements the literature regarding the rarity of breast metastases from small-cell lung cancer in men.Teaching point: Bilateral gynecomastia in a man with a long history of cigarette smoking should be considered with caution.