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When does breast development start in girls?

Breast development is the first sign of puberty in the majority of adolescent females. This can occur as early as age 8 years. Initially, breast development is noticed under the areola, or the nipple area as a hard mobile mass that may be tender. From there, the breast continues to grow and increase until adult size is reached.

One breast is larger than the other. Is this normal?

In many adolescents, budding breasts may not begin to develop evenly. However, by age 18 the size difference should be less obvious. Your physician should be monitoring breast development and check that a breast mass is not the cause for the size difference. If the size difference in the breasts is greater than a cup size, it is important to talk to your physician about different types of treatment.

My bra straps sometimes leave deep marks in my shoulders. Is it because my breasts are large?

Breast overdevelopment or hypertrophy usually begins during puberty and develops over months to years. Many problems are associated with very large breasts such as breast pain, back pain and deep creases in the shoulders due to bra straps. Unwanted attention and problems with peers may also occur due to very large breasts. Your physician should be monitoring your breast development closely and be aware of any problems related to your breasts.

My sister has fibrocystic breasts. What does that mean?

Fibrocystic breasts are breasts with diffuse cord like thickening of the breast tissue with small cysts. The cysts change in size every month and become enlarged and tender before a period and resolve with the end of a menstrual cycle. The pain can occur in both breasts, usually in the upper part of the breasts. Treatment consists of good bra support, analgesics such as ibuprofen and/or oral contraceptives.

My breasts hurt before I have my period. Is that normal?

During a period, hormonal changes occur resulting in changes in the lobules in the breast. They can increase in size resulting in a feeling of fullness or palpation of actual breast masses. Breast pain such as soreness or heaviness radiating to the armpit and arm can also occur with menstrual cycles and resolves with the end of a period. Heat, analgesics such as ibuprofen, supportive bras and evening primrose oil have been shown to be helpful in reducing discomfort.

I feel a lump in my breast. Do I have cancer?

The most common breast mass in adolescents is a fibroadenoma. These benign growths can occur in any part of either breast. They are usually solid, rubbery, movable and usually non-tender. Sometimes fibroadenomas decrease in size or disappear but sometimes they may increase in size. Female adolescents with fibroadenomas have a slightly increased risk of developing breast cancer so monthly self-breast exams are important. Treatment options include monitoring of the fibroadenoma by your physician or surgical removal if physical discomfort or a history of breast cancer exists in the family. Please talk to your physician about your treatment options.

Another common cause of a mass is a breast abscess. These are tender, red masses resulting from skin irritation or infection, infection of a breast cyst, or obstruction of one of the skin ducts. Antibiotics are used to treat abscesses.

Breast cancer in adolescents is very rare but can occur. The mass is usually very hard and located underneath the areola. Breast cancer can occur secondary to other disease such as lymphoma, Hodgkin's disease and leukemia. There is a greater risk for breast cancer in teenagers with a family history of breast cancer. Other physical changes such as bloody discharge from the nipple and skin changes can also occur with other breast masses and tumors. If any of these signs occur, please notify your physician immediately.

When should I start examining my breasts?

A breast exam is part of any routine physical examination for female adolescents. During this time, your physician will inspect and examine the developping breast, palpating the breast for any masses. This serves as a baseline exam to compare for any breast masses be identified in the future. The breast self-examination should also be taught at this time since you will be the first one to notice and recognize any changes. Many physicians recommend monthly breast self-exams once the stages of breast development occur. Your physician should be doing this once a year to monitor for any changes in your breasts.

If any questions exist regarding breast development, changes or problems, please consult your physician or the adolescent medicine department at Nicklaus Children's Hospital, formerly Nicklaus Children's Hospital.

References
Garcia, C.J., Espinoza, A., Dinamarca, V., Navarro, O., Daneman, A., Garcia, H., et al (2000). Breast Ultrasound in Children and Adolescents. Radiographics, 20, 1605-1612
Jonides, L., Rudy, C., & Walsh, S. (1992) Breast Masses in Adolescent Girls. Journal of Pediatric Health Care, 6, 274-276.
Neinstein, L.S. (2002). Breast Disorders. In Neinstein, L.S. (ed), Adolescent Health Care: a practical guide. (pp. 1063 - 1082). Philadelphia, PA: Lippincott Williams and Wilkins.
Pinsonnealult, O. & Goldstein, D.P. (1987). Dysfunctional Uterine Bleeding and Breast Masses in Adolescents. Physician Assistant, 77-85.
Templeman, C. & Hertweck, S.P. (2000). Breast disorders in the pediatric and adolescent patient. Obstetrics and Gynecology Clinics, 27, 19-34.
Weinstein S.P., Conant, E.F., Orel, S.G., Zuckerman, J.A., Bellah, R. (2000). Spectrum of US findings in pediatric and adolescent patients with palpable breast masses. Radiographics, 20, 1613-1621.

Reviewed by: May Lau, MD