The normal anatomy of the breast is shown in Figure
74-1. A variety of benign breast lesions occur in the female
adolescent. The most typical presentation is a self-detected, asymptomatic
mass. Complaints such as bloody discharge, nipple retraction, or
skin dimpling are rare.
Breast asymmetry, a common condition in which
one breast develops earlier or grows more rapidly than the other,
usually occurs between sexual maturity rating (SMR) 2 and 4 and
persists into adulthood in 25% of women. Rare congenital
abnormalities of the breast include amastia (absent
breast, associated with chest wall deformities such as pectus excavatum
or Poland syndrome) and athelia (absent nipple). Polymastia (accessory
breast tissue) and polythelia (accessory nipples)
occur along the mammalian nipple line in 1% to 2% of
girls and may be inheritable conditions. Breast atrophy developing
after thelarche can be one sign of an eating disorder or other chronic
illness such as scleroderma. The associated loss of both fat and glandular
tissue in the breast results from significant weight loss. Virginal
(juvenile) hypertrophy, the massive enlargement of one
or both breasts caused by either increased tissue sensitivity to
pubertal hormones or endogenous production of hormones from within
breast cells, can be associated with a variety of problems, including
headache, neck and back pain, dermatitis, embarrassment, and psychological difficulties.
Reduction mammoplasty after completion of breast maturation may
be indicated in female adolescents with severe virginal hypertrophy.
Medications such as medroxyprogesterone and danazol are not effective
in the reduction of mammary hyperplasia in adolescents.1,2
The most common breast masses in adolescents are solitary
cysts,fibrocystic change, and fibroadenomas.
Masses resulting from inflammation or trauma occur less frequently. Cancer
is rare among female adolescents. A solitary cyst contains sterile
fluid. Over half resolve spontaneously within 2 to 3 months, so fine-needle
aspiration or biopsy is often unnecessary. Recurrent or multiple
cysts in the adolescent may represent early fibrocystic change.
Fibrocystic change (benign proliferative breast change) is a
physiological response of breast tissue to cyclic hormonal activity.
The result is a dilation and proliferation of duct epithelium to
form gross cysts. A benign condition more common during the third
and fourth decades, fibrocystic change may occur during adolescence.
Bilateral breast pain in the upper outer quadrants beginning in
the premenstrual phase of the menstrual cycle and subsiding thereafter
is the typical presentation. Physical examination reveals areas
of diffuse, cordlike thickening as well as discrete mobile lesions, which
often increase in size during the premenstrual period. Early studies
suggesting that methylxanthines (coffee, chocolate, tea, cola) are
factors in the development or exacerbation of fibrocystic change
have not been substantiated.3,4 Supportive care,
including nonsteroidal anti-inflammatory agents for pain and a well-fitting
supportive bra, is the most common approach to treatment. Oral contraceptives
reduce symptoms in 70% to 90% of cases....