Breast disorders in children and adolescents: An overview
- Chantay Banikarim, MD, MPH
Chantay Banikarim, MD, MPH
- Director of Adolescent Medicine
- St. Joseph's Hospital & Medical Center, Phoenix
- Nirupama K De Silva, MD
Nirupama K De Silva, MD
- Clinical Associate Professor
- University of Oklahoma-Tulsa
- Section Editors
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
- Amy B Middleman, MD, MPH, MS Ed
Amy B Middleman, MD, MPH, MS Ed
- Section Editor — Adolescent Medicine
- Professor of Pediatrics, Chief of Adolescent Medicine
- University of Oklahoma Health Sciences Center
Breast development during adolescence is an important marker of the transition to adulthood . Abnormalities or anomalies of normal breast development can result in poor self-esteem or make the adolescent feel self-conscious, but most breast lesions in children and adolescents are otherwise benign and self-limited.
An overview of breast disorders in children and adolescents will be presented here. Breast masses in children and adolescents, gynecomastia in male adolescents, and disorders of the breast in adult women are discussed separately. (See "Overview of breast masses in children and adolescents" and "Epidemiology, pathophysiology, and causes of gynecomastia" and "Clinical features, diagnosis, and evaluation of gynecomastia" and "Clinical manifestations and diagnosis of a palpable breast mass" and "Overview of benign breast disease" and "Breast pain".)
The breasts start forming in the fifth week of embryonic life. They originate from endodermal elements termed mammary ridges. The mammary ridges extend from the embryonic axilla to the inguinal region, but only the area over the fourth intercostal space develops further, while the rest atrophies. Under the influence of steroid hormones during childhood growth and development, the breast buds enlarge, and glandular elements appear . Adipose tissue and lactiferous ducts (lobes of the mammary gland at the tip of the nipple) grow in response to estrogens, while progesterone stimulation causes lobular growth and alveolar budding .
Thelarche typically begins between the ages of 8 and 13 years, with an average age of onset of 10.3 years [3,4]. While the breast bud is one of the first signs of puberty, the estimated mean time for full breast development is 4.2 years . Adolescent breast development is described according to the stages developed by Tanner in 1969 (picture 1) . (See "Breast development and morphology" and "Normal puberty".)
Clinical examination — A breast examination should be included in the annual examination of all children and adolescents [6,7]. Examination of the newborn includes assessment of breast size, nipple position, presence of accessory nipples, and nipple discharge . Asymmetric breast enlargement and/or a thin milky nipple discharge ("witch's milk") related to stimulation from maternal hormones can occur in both males and females. (See 'Congenital abnormalities' below and "Overview of breast masses in children and adolescents", section on 'Neonates and infants'.)
- De Silva NK, Brandt ML. Disorders of the breast in children and adolescents, Part 1: Disorders of growth and infections of the breast. J Pediatr Adolesc Gynecol 2006; 19:345.
- Bock K, Duda VF, Hadji P, et al. Pathologic breast conditions in childhood and adolescence: evaluation by sonographic diagnosis. J Ultrasound Med 2005; 24:1347.
- Pitts SA, Gordon CM. The physiology of puberty. In: Emans, Laufer, Goldstein's Pediatric & Adolescent Gynecology, 6th, Emans SJ, Laufer MR. (Eds), Lippincott Williams & Wilkins, Philadelphia 2012. p.100.
- Biro FM, Greenspan LC, Galvez MP, et al. Onset of breast development in a longitudinal cohort. Pediatrics 2013; 132:1019.
- Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child 1969; 44:291.
- Greydanus DE, Matytsina L, Gains M. Breast disorders in children and adolescents. Prim Care 2006; 33:455.
- DiVasta AD, Weldon C, Labow BI. The breast: Examination and lesions. In: Emans, Laufer, Goldstein's Pediatric & Adolescent Gynecology, 6th, Emans SJ, Laufer MR. (Eds), Lippincott Williams & Wilkins, Philadelphia 2012. p.405.
- Adolescence. In: Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd ed, Hagan JF, Shaw JS, Duncan PM (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2008. p.515.
- US Preventive Services Task Force. Screening for breast cancer. November 2009. www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm (Accessed on November 29, 2011).
- Breast concerns in adolescents. In: Guidelines for Adolescent Health Care, 2nd ed, American College of Obstetricians and Gynecologists, Washington, DC 2011. p.119.
- Dixon JM, Mansel RE. ABC of breast diseases. Congenital problems and aberrations of normal breast development and involution. BMJ 1994; 309:797.
- Templeman C, Hertweck SP. Breast disorders in the pediatric and adolescent patient. Obstet Gynecol Clin North Am 2000; 27:19.
- Ferrara P, Giorgio V, Vitelli O, et al. Polythelia: still a marker of urinary tract anomalies in children? Scand J Urol Nephrol 2009; 43:47.
- Grossl NA. Supernumerary breast tissue: historical perspectives and clinical features. South Med J 2000; 93:29.
- Aughsteen AA, Almasad JK, Al-Muhtaseb MH. Fibroadenoma of the supernumerary breast of the axilla. Saudi Med J 2000; 21:587.
- Oshida K, Miyauchi M, Yamamoto N, et al. Phyllodes tumor arising in ectopic breast tissue of the axilla. Breast Cancer 2003; 10:82.
- Martin VG, Pellettiere EV, Gress D, Miller AW. Paget's disease in an adolescent arising in a supernumerary nipple. J Cutan Pathol 1994; 21:283.
- Skandalakis JE, Gray SW, Ricketts R, Skandalakis LJ. The anterior body wall. In: Embryology for Surgeons: The Embryological Basis for the Treatment of Congenital Anomalies, Skandalakis JE, Gray SW (Eds), Williams & Wilkins, Baltimore 2004. p.552.
- Duflos D, Plu-Bureau G, Thibaud E, et al. Breast diseases in adolescents. In: Pediatric and Adolescent Gynecology: Evidence-Based Clinical Practice (Endocrine Development), Sultan C. (Ed), Karger, Basel, Switzerland 2004. Vol 7, p.186.
- Eidlitz-Markus T, Mukamel M, Haimi-Cohen Y, et al. Breast asymmetry during adolescence: physiologic and non-physiologic causes. Isr Med Assoc J 2010; 12:203.
- Greydanus DE, Omar H, Pratt HD. The adolescent female athlete: current concepts and conundrums. Pediatr Clin North Am 2010; 57:697.
- Capraro VJ, Dewhurst CJ. Breast disorders in childhood and adolescence. Clin Obstet Gynecol 1975; 18:25.
- Rohn RD. Nipple (papilla) development in puberty: longitudinal observations in girls. Pediatrics 1987; 79:745.
- O'Hare PM, Frieden IJ. Virginal breast hypertrophy. Pediatr Dermatol 2000; 17:277.
- Piza-Katzer H. Reduction mammaplasty in teenagers. Aesthetic Plast Surg 2005; 29:385.
- Xue AS, Wolfswinkel EM, Weathers WM, et al. Breast reduction in adolescents: indication, timing, and a review of the literature. J Pediatr Adolesc Gynecol 2013; 26:228.
- Di Noto A, Pacheco BP, Vicala R, et al. Two cases of breast lymphoma mimicking juvenile hypertrophy. J Pediatr Adolesc Gynecol 1999; 12:33.
- Hoppe IC, Patel PP, Singer-Granick CJ, Granick MS. Virginal mammary hypertrophy: a meta-analysis and treatment algorithm. Plast Reconstr Surg 2011; 127:2224.
- Aillet S, Watier E, Chevrier S, et al. Breast feeding after reduction mammaplasty performed during adolescence. Eur J Obstet Gynecol Reprod Biol 2002; 101:79.
- McMahan JD, Wolfe JA, Cromer BA, Ruberg RL. Lasting success in teenage reduction mammaplasty. Ann Plast Surg 1995; 35:227.
- Nguyen JT, Palladino H, Sonnema AJ, Petty PM. Long-term satisfaction of reduction mammaplasty for bilateral symptomatic macromastia in younger patients. J Adolesc Health 2013; 53:112.
- DeSilva NK. Plastic surgery and the adolescent breast: preliminary patient counseling. J Pediatr Adolesc Gynecol 2010; 23:184.
- American Society of Plastic Surgeons. Policy statement: Breast augmentation in teenagers. www.plasticsurgery.org/Documents/medical-professionals/health-policy/key-issues/Policy-Statement-on-Breast-Augmentation-in-Teenagers.pdf (Accessed on July 25, 2011).
- US Food and Drug Administration. Risks of breast implants www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm064106.htm (Accessed on August 23, 2012).
- Quint E, Engelland A, Strauch B. Management quandary. Breast reduction in the adolescent. J Pediatr Adolesc Gynecol 2004; 17:147.
- Cerrato F, Webb ML, Rosen H, et al. The impact of macromastia on adolescents: a cross-sectional study. Pediatrics 2012; 130:e339.
- ACOG Committee on Adolescent Health Care. ACOG Committee Opinion No. 350, November 2006: Breast concerns in the adolescent. Obstet Gynecol 2006; 108:1329.
- Gumm R, Cunnick GH, Mokbel K. Evidence for the management of mastalgia. Curr Med Res Opin 2004; 20:681.
- Schairer C, Brinton LA, Hoover RN. Methylxanthines and benign breast disease. Am J Epidemiol 1986; 124:603.
- Levinson W, Dunn PM. Nonassociation of caffeine and fibrocystic breast disease. Arch Intern Med 1986; 146:1773.
- Jacobson MF, Liebman BF. Caffeine and benign breast disease. JAMA 1986; 255:1438.
- Santen RJ, Mansel R. Benign breast disorders. N Engl J Med 2005; 353:275.
- Baren JM. Breast lesion. In: Textbook of Pediatric Emergency Medicine, 5th ed, Fleisher GR, Ludwig S, Henretig FM (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.193.
- Rohn RD. Galactorrhea in the adolescent. J Adolesc Health Care 1984; 5:37.
- Kelly VM, Arif K, Ralston S, et al. Bloody nipple discharge in an infant and a proposed diagnostic approach. Pediatrics 2006; 117:e814.
- Saff DM, Owens R, Kahn TA. Apocrine chromhidrosis involving the areolae in a 15-year-old amateur figure skater. Pediatr Dermatol 1995; 12:48.
- BREAST DEVELOPMENT
- BREAST EXAMINATION
- Clinical examination
- CONGENITAL ABNORMALITIES
- Accessory breast tissue
- Athelia and amastia
- ABNORMALITIES OF SIZE AND SYMMETRY
- Neonatal breast hypertrophy
- Small breasts
- Breast asymmetry
- Tuberous breast
- Breast atrophy
- Juvenile breast hypertrophy
- Surgical management
- - Breast augmentation
- - Breast reduction
- BREAST PAIN
- NIPPLE DISCHARGE
- Clinical evaluation
- Differential diagnosis
- BREAST INFECTION
- BREAST MASSES