Breast Health in Teens

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14-year-old noticed lumps in her breast

Aug 2010

My 14 y.o. daughter recently noticed breast lumps and we went to her pedicatrician. I can see based on the pediatrician's commments when I first called, and at the appointments that she (the pediatrician) has decent amount of experience with this and generally I find her quite good. In our case, we went back 3 times as doctor wanted to check at a different times in the cycle. Third time found no ''lumps'' but something she described as stringy in different locations than the initial lumps. Pediatrician is confident my daughter has fibrous breast tissue, and no need to worry about current stringy spots. She feels we should let it go unless a persistent or growing lump appears. She is willing to refer to specialist if we want, but doesn't recommend it and feels it would be unwarranted intervention at this time. I'm wondering if we should go to specialist to get further input/education and look into getting an ultrasound just to have a baseline (analogous to 40 yo or 50 yo mamogram baseline, but really I have no idea if this analogy makes sense). I am a little concerned that now that my daughter has received assurances from the doctor she will not be as attentive as maybe she should be about checking her breasts and reporting possible lumps. Please pipe in if you have experience or knowledge about care for teens with fibrous breasts. Thanks. anon

I'm a nurse and breast cancer survivor. I strongly recommend you see the specialist for a second opinion. Even the most confident doctor can miss things. I would do this if it were my daughter. Also, you might want to do a Google search for a site that offers education and support about teens and breast health. Nancy
Just some backgroung: I was a health educator for the national cancer institute for 10 years. Sounds like you are worried about breast cancer with your 14 year old? The chances of her getting breast cancer in the next decade are so exceedingly small that they pale in comparison to other risks that a teen her age faces like falling off her bike, getting hit by a car or getting alcohol poisoning. These are risks worth worrying about so please save your worry for them.

Here are the official NCI stats by age group. SEER breast cancer Incidence From 2003-2007, the median age at diagnosis for cancer of the breast was 61 years of age. Table I-11 ( 1975_2007/results_single/sect_01_table.11_2pgs.pdf). Approximately 0.0% were diagnosed under age 20; 1.9% between 20 and 34; 10.5% between 35 and 44; 22.6% between 45 and 54; 24.1% between 55 and 64; 19.5% between 65 and 74; 15.8% between 75 and 84; and 5.6% 85+ years of age. The overall age-adjusted incidence rate was 122.9 per 100,000 women per year. So your daughter has a 0.0% chance out of the 123 women per 100,000 who are likely to get breat cancer. Of course the 0.0 figure is rounded so it is not absolute zero but it is very close to that.

Ultrasound is useful in distinguishing between cysts (fluid filled sacs that are not associated with cancer) and solid masses in the breast tissue of older women. I don't know if there is any information on its efficacy in a 14 year old. Becasue of the denser breast tissue in a 14 year old, the imaging may be poor.

Many younger women have fibrous or stingy breast tissue. It is nothing unusual. As a woman ages the breast generally gains fatty tissue. One reason mammagraphy is not used on younger women is becasue they have denser breast tissue (less fat) and the x-ray images are less clear and therefore less helpful. The other reason is that breast cancer occurs far more often in older women than younger. Sean

18-year-old's inverted nipples

Nov 2006

My 18 year old daughter has told me that she has inverted or flat nipples and this was confirmed by her pediatrician. While the pediatrician told her there was no need to be concerned, she is very unhappy about this. I think she tried a mail order product to pull out the nipples (don't know which product) but without success. She is now considering plastic surgery for her nipples. I am appalled by this consideration as the surgery can affect the possibility of sucessful breastfeeding later in life, not to mention the cost and what it means in terms of body acceptance. She will coming home from college soon and we will be discussing this. I am wondering if anyone has dealt with this issue themselves or with their teen. Specifically I am wondering if anyone knows about a non-surgical product that has been successful in bringing out inverted nipples permanently. I have read about a product called the Avent Niplette but don't know anyone who has tried it or its efficacy. Also, does anyone know any great books or articles about body acceptance especially ones that might address this issue? Lastly, has anyone ever had this surgery or know someone who did? I know teens do not like to look differently than their peers but plastic surgery seems like a pretty drastic measure. Thank you for your feedback! anonymous

Mine were flat. Breastfeeding fixed it. --Like everybody else now
I can relate to feeling different with inverted nipples. Mine were like that until I gave birth and started to breast-feed. Then, poof -- they were no longer inverted! So please, no surgery! In the meantime, tell your daughter they're special because they're more sensitive (like an uncircumcized penis), her nipples only come out to play. My partner compared them to a flower that blossoms at night. And she has the extra advantage of not worrying about being embarrassed that her nipples are showing when it's cold outside! anon
I only found out that I have flat nipples when I had my first child and was able to correct them by wearing special plastic ''shells'' in my bra. there are also certain rolling excercises she can do to stretch and break the tissue-it does not hurt at all. It would be great if she would get in touch with a local lacation consultant(fee) or a LLL (La Leche League) Leader (free of charge) to hear about the newest products on the market for this issue. I sure hope she will not need to have surgery on her breasts. Should she need a consultation with a plastic surgeon I highly recommend dr. Chang in San Francisco, who has helped my daughter with a different breast issue
Do a Pubmed search It is the database of the Nat. Lib. of Med. Enter ''inverted nipples'' in the search box, hit GO and there are 136 medical journal articles on the subject. Maybe 50 will be useful to your daughter. If you need help with the search or reading the jargon-laden articles, email me. Some Pubmed sample titles:
-Correction of inverted nipples. -Usefulness of the nipple-suspension piercing device after correction of inverted nipples. -Correction of the inverted nipple with an internal 5-point star suture. -Correction of congenital nipple inversion with bilateral rhombus deepithelialized subcutaneous pedicle skin flaps and continuous traction.
They all seem to be from plastic surgery medical journals so it seems this is the standard of care. Re. worry about breast feeding; while yes, this IS plastic surgery, it is probably a very simply surgical procedure with tiny incisions and with almost no risk of damaging the numerous thin milk ducts leading to the nipple, and with minimal scaring. But I'm not a surg. and haven't read these articles.

I think you are overreacting to the idea of surgery since this is probably a VERY minor surg. We are not talking about a face lift. You state that, ''the surgery can affect the possibility of sucessful breastfeeding later.'' Does the medical literature actually back your assertion up? If this is a possiblility, what percent of patients have this unfortunate side effect? 0.4%, 65%? Also, how is breast feeding affected by leaving the nipples inverted? Does the inversion make it difficult for the infant to grasp the nipple to begin feeding? Do inverted nipples pop out when the breasts are engorged with milk? What are the typical psychosexual effects on women with this condition? Extreme embarrasment? Abnormal avoidance of normally desired sexual situations? I don't know, but a 15 minute consultation with a plastic surgeon should answer these questions.

From the few jour. article abstracts I did read, the problem is not pulling the nipple out, it is KEEPING it out. You seem to be under the mistaken impression that once the nipple ''pops'' out, it is fixed. I'm sure your daughter can grasp her nipple with her fingertips and simply pull it out. Problem is, it doesn't stay. This is caused by the anatomical anomaly of having too little supporting tissue beneath the nipple. That's why surg. is necessary.

I would suggest you force yourself to take as neutral a role in your discussions about this fairly common condition with your daughter as you can. Educate and support, don't judge. I think you really owe it to your daughter to at least discuss this with one or two plastic surgeons. Sean