Breast Masses Rapid Fire Session: Update Course 2015

Telarchy (breast development) is considered normal at 9-10 years of age, premature at 7-8 years, and delayed at 12 years.

Normal anatomic structures that can present as breast masses include lymph nodes, breast bud (due to maternal hormones in infants), asymmetric breast development in older children, and bony structures.

Gynecomastia is due to circulating estrogens in males and can be associated with medications, illegal drugs, and herbal supplements; it is usually self-limited.

Non-neoplastic breast tumors in children include cysts, hematomas (usually associated with chest wall trauma), abscesses, and galactoceles.

The most common benign breast mass in children is fibroadenoma; other benign masses include hematomas, intraductal papillomas, juvenile papillomatosis, and fibrous nodules.

The most common malignant breast mass in children is metastatic disease; phyllodes tumors and primary chest wall malignancies are less common.

The most important initial management of pediatric breast masses is a good history and physical examination.

Fibroadenomas have characteristic features: small, smooth, lobular, movable, may be tender during menstrual periods, and not associated with overlying skin changes.

Mammography should be avoided in pediatric breast masses due to radiation dose and lack of diagnostic utility.

Ultrasound examination of fibroadenoma is considered very diagnostic with a high degree of specificity and sensitivity.

In the speaker's practice, all breast lumps (fibroadenomas) are excised regardless of size.

Family history of breast cancer and family preference influence the decision to excise versus observe fibroadenomas.

For a 3 cm fibroadenoma that is not visible and not bothering the patient (completely asymptomatic), observation is a reasonable approach.

Asymptomatic fibroadenomas can be followed up once at 3 months for reassurance, but do not necessarily require ongoing surveillance.

Fibroadenomas are always benign but can grow and become symptomatic.

If a fibroadenoma grows and is excised when larger, the resulting scar will be bigger.

Biopsy or excision should be considered if there is discharge, skin dimpling, or other features suggesting malignancy.

There are exceedingly rare case reports of breast cancer in teenagers.

Many teenage girls with fibroadenomas want them excised even when asymptomatic.

Patient preference is a consideration in the decision to excise fibroadenomas, even when ultrasound is diagnostic.

One approach is not to schedule routine follow-up for observed fibroadenomas, but to instruct patients to return if the mass grows.