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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....

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