Teens can be frightened by variations in normal breast development or common benign conditions. While supportive care is usually sufficient, some disorders require investigation.
One confusing aspect of breast development for females is the normal phenomenon of one breast beginning development before the other. The appearance of the breast bud or thelarche occurs, on the average at 9.8 years in the U.S. Some girls may exhibit significant breast asymmetry. They should be reassured that catch-up growth typically occurs by late adolescence.
Causes of breast masses in adolescent females are:
*Fibroadenoma
*Fibrocystic change
Giant juvenile fibroadenoma
Breast cyst
Mastitis/breast abscess
Cystosarcoma phyllodes
Trauma (hematoma, contusion, fat necrosis)
Mammary duct ectasia (dilation)
Pregnancy
Lactational changes
Breast cancer
Intramammary lymph nodes
The first two (*) are by far the most common. Breast cancer is extremely rare in this age group.
The question of whether young adolescent girls should be taught breast self-examination (BSE) is controversial because of the low risk of breast cancer in this age group and the potential for anxiety and the necessity for testing if a mass is found. The main reason to teach BSE is to help the adolescent girl feel more comfortable about her body and acclimate her to how her breasts feel normally, so that when she reaches the age at which she becomes at risk for breast cancer (over age 25), she will know what is normal for her.
In males, gynecomestia at puberty is a common cause of concern. Although usually a normal developmental phenomenon, breast enlargement, with or without tenderness, can be caused by other things, including:
- Medications (e.g. anabolic steroids) CNS tumor Substances of abuse (e.g., marijuana) Klinefelter syndrome Renal failure Adrenal tumor Liver disease Testicular failure Thyroid disease Starvation/malnutrition
- Additional drugs which can cause gynecomastia are: androgens, tricyclic antidepressants, benzodiazepines (Valium and similar tranquillizers), phenothiazines, ketoconazole, isoniazid, theophylline and anti-cancer agents.
The most common congenital anomaly of the breast, polythelia or supernumerary nipples, occurs in approximately 2% of the population. These extra nipples can occur anywhere along the mammary line, from the neck to the public area and are seen in both males and females.
Nipple Discharges
Jogger's nipple is caused by nipple irritation during exercise which may cause a serosanguineous discharge. The cause appears to be constant rubbing of the covering garment. Preventive measures such as wearing a supportive bra and protecting the nipple with a small bandage or lubricating with jelly or moisturizer are helpful.
Galactorrhea. This term describes the inappropriate secretion of milk from the breast. A smear of the nipple discharge that stains positive for fat globules is diagnostic. The most common etiologies of galactorrhea are physiologic, that is, postpartum and posttermination of pregnancy. Another common cause is nipple stimulation during sexual play. Certain brain tumors (pituitary) can also cause expression of milk from the nipple.
In summary, for most teens, the only breast care needed is a physical examination and reassurance that breast development is normal.
(Alderman E. Breast problems in the adolescent. Contemporary Pediatrics 1999; 16(9):99-120).
COMMENT: Jogger's nipple is new news to me. The athletic folks in my district indicate that jogger's nipple is seen primarily in marathon runners. - R.A.
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