Pediatric Breast Pathologies: 5-Year Experience and Proposal for a Risk-Based Management Algorithm

Breast complaints in children are uncommon, and standardized management guidelines are lacking. Adult-based protocols are often extrapolated to pediatric patients despite differences due to breast development and different disease behavior. We aimed to review our institutional experience and propose a practical, evidence-informed diagnostic and management algorithm.

A retrospective review was conducted of all female pediatric patients who presented with breast-related complaints to a tertiary pediatric surgery clinic between June 2020 and June 2025. Demographic and clinical characteristics, imaging findings, treatments, and histopathological results were analyzed.

A total of 293 female patients (mean age 14.2 ± 3.5 years; range 1-18) were evaluated. The most common presenting complaints were pain (47.4%) and palpable mass (41.9%). Ultrasonography was performed in 96.9% of patients, and breast masses were detected in 68.6%. During a mean follow-up of 31.4 ± 3.8 months, 81% of masses remained stable or regressed, and only 3.9% required surgery. Histopathology revealed fibroadenoma (55.6%), benign phyllodes tumor (22.2%), pseudoangiomatous stromal hyperplasia (11.1%), and accessory nipple tissue (11.1%).

No malignancy was detected in any patients who underwent biopsy or surgery in the present study. Most pediatric breast lesions are benign and can be managed conservatively with periodic clinical and ultrasonographic follow-up. Magnetic resonance imaging appears to be a valuable adjunct in selected cases with indeterminate imaging findings. A stepwise, risk-stratified algorithm was developed to guide the evaluation and management of breast masses in children. This approach may minimize unnecessary interventions while ensuring safe surveillance of pediatric breast lesions.