Breast masses in adolescent girls

Key Points

Breast masses can cause anxiety for adolescent girls and their parents. Pediatricians will see many patients presenting with this common complaint. This article reviews normal breast development, breast examination, breast tissue variants, common breast masses, and recommended standards of care, so that pediatricians can confidently evaluate, diagnose, and manage breast masses.

Normal breast development

Breast masses can arise during any stage of puberty, so it is important to understand normal breast development. Thelarche (initiation of breast development) usually begins between the ages of 9 and 10 years.¹ Sexual maturity rating (SMR) or Tanner stages are used to describe breast development.² The prepubertal stage is SMR 1, before breast development has begun. The development of budlike breast growth underneath the areola is SMR 2. It is important not to mistake this beginning stage of breast development as a breast mass. In SMR 3, there is a greater volume of breast tissue, and the areola is larger but lays flat against the contour of the breast tissue. Larger breast size and a larger raised areola, which forms a second mound on top of the breast tissue, characterizes SMR 4. Some females remain in SMR 4 as adults. The final stage is typically SMR 5, in which breasts attain adult size, and the areola returns to the contour of the breast tissue.

Taking a medical history. A thorough history provides crucial information in the evaluation of a breast mass. Question the patient about breast self-exam (BSE) performance and its timing in relation to the menstrual cycle, how long the mass has been present, changes in the size of the breast or mass, associated pain, the presence of any areas of redness, and nipple discharge. Ask about variations in mass size and pain during the menstrual cycle. Changes in mass size that occur with the menstrual cycle suggest a cyst.³ Medical history taking should include questions about past or current malignancies and prior radiation to the chest and axilla, because some malignancies can metastasize to the breast, and radiation predisposes an individual to cancer. Assess the patient's current medications, caffeine intake, history of trauma, and family history (first-degree relatives and aunts) of any breast masses, breast cancer before menopause, or ovarian cancer. Eliciting the parental perspective regarding the breast mass is essential, because the parent may be more concerned about the mass than the patient.