Breast Symptoms-Teen

• Breast symptoms in an older girl or teen
• Breast development (and puberty) has begun or is completed

Symptoms included in this guide are:

• Breast pain (most common complaint)
• Breast lump
• Breast size, shape or symmetry questions
• Redness of breast
• Nipple discharge

Causes of Breast Symptoms

• Breast lump: fibroadenoma, cyst. See Breast Lump details below
• Nipple discharge: milk, blood, pus, clear fluid
• Acute breast pain with redness (only on 1 side): often an infection.
• Acute breast pain and fullness without redness (same on both sides): always consider pregnancy
• Recurrent breast pain with menstrual periods: cyclic mastalgia. See details below.
• Chronic breast pain, unrelated to menstrual period and usually just one side: fibroadenoma, cyst. Marijuana use can cause breast pain.

Premenstrual Breast Pain and Swelling

• Main Symptom: breast fullness and pain.
• Cause: extra body fluid from female hormone cycles.
• Other symptoms: headache, swollen feet (edema).
• Timing: mainly noticed in the week prior to menstrual periods.
• Course: improves during menstrual period and goes away between menstrual periods.
• Physical Findings: fullness that can be felt throughout both breasts.
• Onset: usually 2 years after onset of periods (with onset of ovulation). Similar onset as for menstrual cramps.
• Frequency: 10% of teens and 50% of adult women.
• Treatment: mainly ibuprofen and support bra. If breast pain can't be controlled with ibuprofen, 80% can be improved by birth control pills.
• Other treatments: daily exercise and getting enough sleep.

Breast Lumps in Adolescents: Causes

• Breast masses in teens are almost always benign (not cancer).
• Breast cancer is very rare in teens (2 cases per million in young women)
• Fibroadenoma: most breast masses in teens are fibroadenomas. They are 1 inch (2.5 cm) oval or round, rubbery, non-tender mass. Most often in upper-outer quadrant of breast. Not associated with breast cancer. Natural course: 50% go away within 5 years, others need removal.
• Juvenile fibroadenomas: breast masses that are larger than 2 inches (5 cm) in size. Benign, but need to be removed by surgery.
• Breast cysts
• Breast abscess: this is a red, painful lump. Main cause is Staph bacteria. Main triggers are nipple injury, nipple piercing or lactation (producing breast milk). Needs oral antibiotics and needle removal of the pus.
• Breast collections of blood (hematomas) from injury: may take weeks or months to resolve.

Go to ER Now

• Breast injury from assault

Call Doctor or Seek Care Now

• Breast is painful to touch
• Red area or red lump with fever
• Nipple discharge that is pus (thick green or yellow) or bloody
• Your teen looks or acts very sick
• You think your teen needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Red area or red lump without fever
• You think your teen needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Other breast lumps
• Could be pregnant (breast fullness/tenderness and missed menstrual period)
• Change in shape or appearance of breast
• Nipple discharge that is clear or milky
• Breast pain and cause is unknown. Exception: continue if only occurs before menstrual periods or with vigorous exercise.
• Age 13 or older with no breast buds or breast tissue
• You have other questions or concerns

Self Care at Home

• Breast pain in both breasts occurs monthly before menstrual periods
• Breast pain after exercise
• Breasts are not the same size, questions about (normal breast asymmetry)

Care Advice for Breast Symptoms - Teen

Breast Pain or Tenderness Before Menstrual Periods

1. What You Should Know:
   • Some teens (10%) have breast pain and fullness on a monthly basis. This occurs just before their menstrual period.
   • The discomfort can range from mild to moderate.
   • Pain and swelling goes away between menstrual periods.
   • Cause: normal changes caused by hormone cycles.
   • Medical name: cyclic mastalgia.
2. Pain Medicine:
   • Ibuprofen is best for this type of pain. Give ibuprofen every 6 hours, as needed.
   • If you don't have ibuprofen, give acetaminophen every 4 hours. Do this until you can get ibuprofen.
3. Wear a Support Bra:
   • Wear a well-fitted support bra or sports bra when breast pain occurs.
   • This is especially important when you exercise.
   • Some women with large breasts are more comfortable wearing a bra even when sleeping.
4. Reduce Caffeine:
   • Some women report increased breast pain after drinking coffee or colas.
   • If that applies to you, avoid caffeine or reduce your intake.
5. Expected Course:
   • Should go away between menstrual periods.
   • If symptoms are not better between periods, make an appointment to see your doctor.
6. Breast Self-Examination (BSE):
   • The American College of Obstetricians and Gynecologists (ACOG) does not recommend teaching teens BSE until age 18 years.
   • Reason: incidence of breast cancer between age 15 and 19 years is low (2 cases per million girls).
   • BSE is best learned in person from a health care provider. If you are over 18, make an appointment to discuss this with your provider.
   • Best time for BSE is at the end of each menstrual cycle. Lumps are easiest to feel at that time.
7. Call Your Doctor If:
   • Breast pain doesn't go away between periods
   • You miss a period or pregnancy test is positive
   • You feel a lump
   • You think your teen needs to be seen
   • Your teen becomes worse

Breast Pain During or After Exercise

1. What You Should Know:
   • Breast pain during or following hard exercise is common.
   • Cause: stretching of ligaments inside the breast.
   • Most common in girls with large breasts.
   • Large breasts may also cause back pain.
   • The pain most often lasts 1 or 2 days.
2. Wear a Sports Bra:
   • Wear a good quality sports bra when you exercise.
3. Pain Medicine:
   • Ibuprofen is best for this type of pain. Give ibuprofen every 6 hours, as needed.
   • If you don't have ibuprofen, give acetaminophen every 4 hours. Do this until you can get ibuprofen.
4. Call Your Doctor If:
   • You feel a lump
   • Breast pain lasts more than 2 days
   • You think your teen needs to be seen
   • Breast pain becomes worse

Breast Size Unequal

1. What You Should Know:
   • A difference in breast size is common and normal.
   • At puberty, breast development most often starts on one side before the other.
   • While breasts are growing, 50% of girls have breasts that are different sizes.
   • After the breasts are mature, 25% of women still have unequal breasts. Usually the left is larger.
   • The difference is most often minor.
   • Medical name: normal breast asymmetry.
2. Treatment for Breast Asymmetry:
   • Wearing a bra pad on the smaller side is an option.
   • After age 18, if the difference is major, referral to a plastic surgeon can be considered.
3. Call Your Doctor If:
   • You think your teen needs to be seen
   • You have other questions or concerns