A 13-year-old girl is brought to her pediatrician by her mother because of a left breast mass, which she has noted for the past month. The lump has been very painful and “changed” in color (Figure 80-1). Her mother is concerned about the size of the lump, having seen it only three days prior to her visit. The patient reached menarche at age 12 years and is not taking any medications. She has never been pregnant. The diagnosis of giant fibroadenoma was suspected and the girl is referred to a breast surgeon. Given the size of the lesion, and severe asymmetry, it was advised that she have an excision of this mass with reconstruction to achieve a better cosmetic result. She underwent surgical excision of the mass, which confirmed a giant fibroadenoma. After the procedure, her breasts appeared symmetrical and she healed very well.There is concern that her left reconstruction may need to be revised in the future as her other breast will mature appropriately for her age. This will need to be followed into adulthood.

Breast masses in female adolescents can range from normal breast tissue to cysts to fibroadenomas to malignancies. The most common cause of breast masses in adolescent girls is a fibroadenoma, which is a benign, well circumscribed lesion composed of abundant stromal and epithelial components. Despite the benign nature of fibroadenomas, accurate diagnosis and management will help alleviate significant fears that are associated with these lesions.

• Fibroadenomas are the most common breast lesions in adolescent girls.^1,2

• These occur in about 10 percent of all women, and have a peak incidence in the second and third decades of life.

• Fibrocystic changes of the breast are common in adolescents, although the exact prevalence is not known.²

• Female adolescents usually go through breast development and growth during puberty (Figure 80-2). Knowledge of normal development is important in the diagnosis of breast masses in adolescents.

• Pathology of the lesion determines the type of lesion: Cysts are fluid filled masses. Fibroadenomas are fibroepithelial lesions which are filled with numerous cells.

• Fibrocystic changes are thought to result from an imbalance between estrogen and progesterone.

• Women who have fibroadenomas do not appear to have an increased risk of developing breast cancer; however, it is important to note that about 2 percent of carcinomas arise in a fibroadenoma. For this reason, fibroadenomas are usually followed to assure stability over time. Growth beyond 5 cm is consistent with a giant fibroadenoma.

• Fibroadenomas are very responsive to hormonal changes and enlarge during pregnancy or prior to the menses.

• Women in their 20s to 30s are at higher risk, although fibroadenomas are the most common causes of breast lesions in adolescents.

• Hormone exposure such as pregnancy or use of birth control pills.

• Having previous fibroadenomas make women susceptible to having more in the future.

• The role of caffeine as a risk factor for fibroadenomas is not clear.^3–5

A careful history and physical examination is the first step in the diagnosis of breast lesions in adolescents. Most often, observation of the mass for one to two menstrual cycles will aid in the diagnosis and help rule out more serious causes. In equivocal cases, ultrasonography and/or needle aspiration are helpful.