In this lecture, we will discuss breast masses in adolescent patients. Breast cancer is very rare in adolescents,
even in adolescents with BRCA1. So, we have to think about other causes as this sometimes comes up
during practice. So, let’s go through some of the background of adolescent breast development.
There is pubertal breast development which mainly is under the influence of both estrogens
which create lactiferous ducts and progesterone which creates lobular tissue and alveolar budding.
The female adolescent breast tissue is very dense and is responsive to hormonal changes.
Therefore, many breast masses are found incidentally and are simply fibrous dysplasia or bumps
within the breast tissue. Fibroadenomas are usually benign. It is the most common breast mass
in an adolescent. Remember, breast cancer is rare in adolescents. Adolescents are only less than 1%
of patients with breast tumors. Now, when we look at an exam and we are examining a breast,
we need to do two careful aspects of our exam, first the inspection and then the palpation.
This is to look for that very rare case of mass. So, we will inspect and look for asymmetry, look for skin
changes and look for color changes on the skin of the breast. Then we palpate. We need to note
the location, the size, the mobility of a breast mass. Generally, masses are less mobile if they are cancer.
The consistency of them, usually masses that are cancer are firm or rubbery. We, of course, inspect
for nipple discharge. If we suspect a mass of being potentially cancer, we would order an ultrasound.
That’s usually our test of choice. Mammography in adolescents is not usually recommended
due to the high density of the breast tissue in an adolescent breast. If we see something concerning,
we can do a fine needle aspiration of that breast mass and send it for cytology and pathology.
The therapy for fibroadenomatous in the adolescent are very similar to the therapy for adults.
Generally, most require only clinical follow-up, just keep an eye on things. Very rarely, we might do
surgical excision for asymptomatic or a rapidly growing lesion. NSAIDs or oral contraceptive pills
may be used to help with pain with hormone dependent changes in the breast.
So, let’s move on though to mastitis. Mastitis is a common infection of the breast
especially in lactating adolescents. It’s caused by Group A Strep or Staph aureus.
It may present early with just fever. Fever with no clear source in a lactating woman may well be mastitis.
They eventually then develop into an erythematous confluent painful rash. The fever is common.
We usually treat with cephalexin or clindamycin. Sometimes infection of the breast can get worse
and become a breast abscess. For these patients, we do need antibiotics and sometimes
we might lean towards clindamycin being concerned about MRSA. They generally will respond well
to warm compresses that may help it to drain but sometimes these patients do require surgical drainage.
Whatever the case may be, if a breast is infected, it’s usually a good idea to have the infant eat
at the infected breast. It keeps things flowing and helps those lactiferous ducts drain.
So, that’s my review of breast masses in adolescent girls. Thanks for your time.