BREAST DISORDERS IN CHILDREN

Most breast disorders in children of either sex are benign. Congenital lesions are: absent or multiple breast. Transplacental hormonal influence in neonates may cause hyperplasia of breast tissue with predisposition to infection (Mastitis neonatorum). Premature hyperplasia (thelarche) in females is the most common breast lesion in children. It occurs before the age of eight as a disk-shaped concentric asymptomatic subareolar mass. Remains static until changes occur in the opposite breast 6-12 mo later. It can regress spontaneously or stay until puberty arrives. Biopsy may mutilate future breast development. On the contrary, discrete breast masses in males cause concern and excision is warranted. Gynecomastia is breast enlargement cause by hormonal imbalance, usually in obese pre-adolescent boys. If spontaneous regression does not occur, it can be managed by simple mastectomy. Virginal hypertrophy is rapid breast enlargement after puberty due to estrogen sensitivity. If symptomatic, management is reduction mammoplasty.

Breast enlargement is commonly seen in newborns babies, a condition associated with clear or milky nipple discharge. Maternal hormones are considered the culprit. On rare occasions the mother of an infant will bring to you the attention that the child is having intermittent episodes of bleeding through the nipple. In infants it is a benign, self-limited condition that should be managed conservatively (it could take six months to go away). The main reason of bloody nipple discharge is mammary ductal ectasia, which extends down to the collecting tubules. Mammary duct ectasia was first reported in 1983, characterized by dilatation of the subareolar duct system, and by inflammatory reaction and fibrosis. The infant's own endocrine system is responsible for breast enlargement and mammary duct ectasia, though infection has also been postulated as etiologic factor. Surgical procedures should be avoided, because injury to the breast bud may cause permanent damage. Stimulation or massages to the breast should also be avoided. When associated with hypertrophied mammary glands, prepubertal gynecomastia should be sought.