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Breast Symptoms-Teen

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Definition

  • 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.
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When To Call

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)
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Care Advice

Breast Pain or Tenderness Before Menstrual Periods

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.

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.

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.

Reduce Caffeine:

  • Some women report increased breast pain after drinking coffee or colas.
  • If that applies to you, avoid caffeine or reduce your intake.

Expected Course:

  • Should go away between menstrual periods.
  • If symptoms are not better between periods, make an appointment to see your doctor.

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.

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

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.

Wear a Sports Bra:

  • Wear a good quality sports bra when you exercise.

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.

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

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.

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.

Call Your Doctor If:

  • You think your teen needs to be seen
  • You have other questions or concerns

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Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2024. Schmitt Pediatric Guidelines LLC.
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