Breast Problems

Condition: Breast Problems (breast lumps/cysts/masses, breast pain, breast abscess, gynecomastia, premature thelarche, fibroadenoma)

Overview (“What is it?”)

  • Definition:  There are several breast conditions that can occur in children.
    • Breast mass:  Abnormal mass or lump in the breast 
    • Fibroadenomas:  Benign (non-cancer) breast lumps most often seen in teenage girls
    • Mastalgia:  Breast pain 
    • Premature thelarche:  Early breast development in girls six months to nine years of age. This is not typically problematic.
    • Gynecomastia:  Benign breast enlargement in a male
    • Fibrocystic changes:  Term used to describe the normal lumpy nature of the developing breast
    • Breast abscess:  Infection of the breast associated with a pus pocket
  • Epidemiology:
    • Fibroadenomas typically occur in girls 15-17 years of age. Accounts for about 90% of solid breast masses in girls.
    • Gynecomastia may occur in 50-60% of teenage boys.
    • Breast abscesses typically occur in infants and in older girls 8-17 years of age. Most often the infection is due to bacteria found on the skin (Staph aureus).

Signs and Symptoms (“What symptoms will my child have?”)

  • Early signs:  The most common sign of a breast problem is a mass or enlargement of the breast. Pain may be present.
  • Later signs/symptoms:  Enlargement of the mass and increasing pain. In case of an abscess or infection, worsening redness of the skin and fever may be present. 

Diagnosis (“What tests are done to find out what my child has?”)

  • Labs and tests
    • In a child or an adolescent, an ultrasound is the best study. Mammograms are not as helpful in this age group.
    • For young girls that have enlargement of breast, some blood tests may be performed to assess for abnormalities in hormone balance.
  • Conditions that mimic this condition:  Normal breast development in young girls or self-limited breast development in adolescent boys.  Breast cancer in young children and adolescents is very rare.

Treatment (“What will be done to make my child better?”)

  • Breast lumps:  As the breast tissue develops in young girls, the tissue can be lumpy and tender at times. Non-cancerous breast lumps are common in teenagers as their breast develops. The most common lumps are called fibroadenomas and usually do not require treatment. 
    • Medicine:  Pain may be helped by acetaminophen (Tylenol) or ibuprofen (Motrin or Advil).
    • Surgery:  If lumps that get bigger (greater than 5 cm), cause a lot of pain or anxiety, or those that have worrisome signs of cancer may need to be removed. The bump can usually be removed using a cut around the nipple.
      • Preoperative preparation:  Your child will have to stop eating several hours before the procedure in order to have an empty stomach for anesthesia.
      • Postoperative care:  You will likely have to do some simple wound care following any surgical procedure. Your child will be told about any limitations to activities after the surgery.
  • Breast pain:  Breast pain can be felt as the breast is developing. The tenderness can be felt commonly during the few days before and days during a girl’s menstrual period.
    • Medicine:  Pain may be helped by acetaminophen (Tylenol) or ibuprofen (Motrin or Advil). Use of supportive bra is helpful. Decreasing caffeine and salt intake may help with the pain. Some people recommend naturopathic treatments such as vitamin E (1,200 IU per day), evening primrose oil (3,000 mg per day), or a combination of both may be helpful in breast pain associated with menstrual period.
  • Breast development:  Sometimes there is early development of breast tissue in young children. This can happen with one side or both sides. It can happen in girls or boys. Observation and routine follow-up examination may be needed.
    • When breasts develop in pre-teen and teenage girls, the breasts are typically firm, lumpy and can be painful especially just before the menstrual period starts. This is normal. It is recommended that decreasing caffeine and salt intake makes the symptoms of breast heaviness and pain better.
    • Medicine:  Pain may be helped by acetaminophen (Tylenol) or ibuprofen (Motrin or Advil).
  • Breast abscess
    • Medicine:  Breast infections or abscesses will often require antibiotic treatment along with drainage of the abscess.
    • Surgery:  Abscesses will sometimes require incision and drainage along with antibiotic therapy. This can be done by sucking out the pus through a needle or through a cut, depending on the size and location of the infection as well as the age of the child.
  • Gynecomastia:  Breast development in boys can occur on one or both sides. It can be seen commonly in obese boys. Sometimes the breast tissue can get smaller. However, if there is significant breast tissue growth, it can cause pain or anxiety and distress.
    • Surgery:  Removal of the breast tissue can be done usually through a cut around the nipple. Regional removal of fat (liposuction) may be required with simple mastectomy (removal of breast tissue, usually through an incision around the nipple).
      • Preoperative preparation:  Some bloodwork may be required before your child undergoes surgery, depending on any other medical conditions. Your child will have to stop eating several hours before the procedure in order to have an empty stomach for anesthesia.
      • Postoperative care:  You will likely have to do some simple wound care following any surgical procedure. Your child will be told about any limitations to activities after the surgery.
  • Risks/Benefits: The risk of a breast cancer in a breast mass in a child is low but regardless, children with breast masses should have regular follow-up examinations. The benefits of surgical excision of breast lumps is often relief of pain, anxiety and worry.

Home Care (“What do I need to do once my child goes home?”)

  • Diet:  Your child may eat a normal diet after surgery.
  • Activity:  Your child should avoid strenuous activity and heavy lifting for the first 1-2 weeks as the cut is healing.
  • Wound care:  Surgical incisions should be kept clean and dry for a few days after surgery. Most of the time, the stitches used in children are absorbable and do not require removal. Your surgeon will give you specific guidance regarding wound care, including when your child can shower or bathe.
  • Medicines:  Medicines for pain such as acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) or something stronger like a narcotic may be needed to help with pain for a few days after surgery. Stool softeners and laxatives are needed to help regular stooling after surgery, especially if narcotics are still needed for pain.
  • What to call the doctor for:  Any fevers, redness or drainage from the incision site or for increased pain/discomfort.
  • Follow-up care:  You should follow up with the surgeon and pediatrician for ongoing monitoring of the breast problem.

Long-Term Outcomes (“Are there future conditions to worry about?”)

  • The prognosis (expected course of the disease) is very good for children with breast masses. Most breast lumps or enlargement will go away on their own. For non-cancerous lumps that are removed, the likelihood of having the lump come back  is low. The likelihood of a breast mass being or becoming cancerous is also low.
  • Boys that undergo removal of enlarged breast tissue typically have resolution of their pain and psychological trauma.

Updated: 11/2016
Author: Patricia Lange, MD
Editor: Marjorie J. Arca, MD