Female breast masses during childhood: a 25-year review

Thirty females were treated at our unit with the diagnosis of breast mass between 1970 and 1995. Twenty-seven girls had surgical intervention; for fibroadenoma (n = 14), cystosarcoma phylloides (n = 5), fibrocystic disease (n = 4), intraductal papilloma (n = 2), metastatic carcinoma (n = 1) and fat necrosis (n = 1), while three patients with fibroadenoma were managed nonoperatively. Surgical complications included a nipple slough and hematoma requiring surgical drainage in two patients after the excision of giant fibroadenomas. Our experience revealed that most of the breast masses can be handled operatively through a circumareolar incision without any major complications. Protection of the developing breast bud, nipple and areola is as important as the appropriate excision of the lesion. A detailed physical examination accompanied with ultrasound scan is sufficient for the correct diagnosis in most cases. Female adolescents presenting with fibroadenoma, fibrocystic disease and cystosarcoma phylloides should undergo surgery after a reasonable observation period of 3-4 menstrual cycles. Excision of discrete, undiagnosed breast masses is warranted. This is indicated first to define the pathology and rule out the rare malignancy, second to obviate enlargement and asymmetry, and third to allay the apprehension of the child and family.