Breast conditions apparent at birth include athelia and polythelia. Newborns should be examined for polythelia because of the conditions that can be associated with it, including renal agenesis, supernumerary kidneys, renal cell carcinoma, congenital cardiac defects, pyloric stenosis, epilepsy, and ear abnormalities.
The 2 main conditions of the breast that can appear in the first few weeks of life are neonatal gynecomastia, with or without galactorrhea, and neonatal mastitis.
Premature thelarche can occur with no other signs of puberty or be the first indication of precocious puberty. Girls with premature maturation should be followed carefully to determine the true cause so that surgically treatable lesions can be managed early.
Prepubertal gynecomastia in boys is rare and usually found with sexual precocity, although some cases are caused by tumors.
Virginal or juvenile hypertrophy, usually beginning at the onset of puberty, can lead to skin ulceration of the breast and psychosocial consequences. Medical treatment with danazol is possible, but may cause permanently suppress ovulation and cyclic bleeding. Surgical options include total mastectomy with an implant or reduction mammoplasty.
Bilateral deficiency of breast growth related to delayed thelarche or puberty in adolescent girls requires endocrine evaluation and karyotyping.
Fibroadenomata are the most common discrete solid masses found in the adolescent breast and large masses should be excised to preserve normal breast tissue and rule out the very small chance of cancer.
Most cystosarcoma phylloides are benign and should be locally excised. Subcutaneous mastectomy is appropriate if they are malignant.
Juvenile secretory carcinoma is a slow-growing tumor that can recur locally and metastasizes to the axillary lymph nodes. This tumor is not hormone-dependent and can occur in both girls and boys, with a mean age of occurrence is 9 years. A simple mastectomy with axillary node sampling is indicated.
Other causes of breast masses in pubertal girls include lesions of the rib, skin, or chest wall, which can be differentiated with a plain chest x-ray or a computed tomography scan.
Metastatic breast masses include rhabdomyosarcoma, Ewing sarcoma, lymphoma, neuroblastoma, ovarian dysgerminoma, and acute leukemia.
The most common disorder of the breast in adolescent boys is gynecomastia. Only 1% of boys find the condition troublesome enough to undergo surgery.
Breast disorders in children encompass a wide range of causes and include developmental anomalies, tumors, infections, hormonal imbalances, and, rarely, trauma. The vast majority of breast conditions in children of all ages are benign. Most breast conditions are age specific. In this chapter, the chronologic presentation of breast conditions will be emphasized (Tables 16-1 and 16-2).
Breast Conditions in Girls
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Table 16-1 Breast Conditions in Girls
|Age (years) ||Lesion ||Diagnosis ||Treatment |
|0–1 ||Developmental ||Neonatal gynecomastia ||Observation |
| ||Infectious ||Neonatal mastitis ||Antibiotics, drainage |
|1–4 ||Developmental ||Premature thelarche ||H&P, bone age endocrine evaluation |
| ||Mass ||Galactocele ||Excision |
| || ||Metastatic nodule ||Excision |
|4–10 ||Developmental ||Precocious puberty ||H&P, bone age ...|
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