Breast asymmetry during adolescence: physiologic and non-physiologic causes

Area of Science:

• Pediatric Endocrinology
• Adolescent Gynecology
• Surgical Oncology

Background:

• Pathologic breast conditions are uncommon in pediatric and adolescent populations.
• Breast lesions in younger individuals typically present differently than in adults and are predominantly benign.

Purpose of the Study:

• To investigate the etiologies and clinical features of breast asymmetry in adolescents with normal endocrine function and sexual maturation.
• To differentiate between physiologic and non-physiologic causes of breast asymmetry.

Main Methods:

• Retrospective review of patient records diagnosed with breast asymmetry at a tertiary pediatric center (1990-2007).
• Analysis included patient history, physical examination findings, imaging results, treatment, and outcomes.
• Eleven adolescent patients (ages 12.5-18 years) were identified.

Main Results:

• Causes of asymmetry included unpreventable medical factors (physiologic, Poland anomaly, scleroderma) in eight patients.
• Preventable/iatrogenic factors (chest tissue biopsy, thoracic drain) affected two patients.
• One patient had combined medical-iatrogenic factors (scoliosis treated with a body brace).
• All patients required breast reconstruction post-development.

Conclusions:

• Severe adolescent breast asymmetry can arise from congenital issues, breast diseases, or medical treatments, potentially causing significant psychological and social distress.
• Physicians must recognize the sensitivity of breast tissue and avoid unnecessary chest wall procedures to prevent iatrogenic asymmetry.
• Accurate medical history and physical examination are key to distinguishing between physiologic and non-physiologic breast asymmetry.