As parents your most valuable asset would be your children and there is no doubt about the fact that you won’t be reluctant to go out of the way at times to ensure the topmost happiness for them. Seeing your child sick would be one of the most devastating moments in your life and satisfactory health care facilities with expert medical advice would be highly comforting and reassuring at such times.
In this week’s Health Capsule we are going to discuss one of the commonest complaints, pediatricians come across when mingling with girls around the pubertal age; painful one-sided breast lump. To know more about the medical aspect of this condition we spoke with Dr. H.T Wickramasinghe, a consultant pediatrician.
“Your daughter, in her pre-pubertal age, complaining of a pain in the breast and you, feeling a lump around the particular area, can be extremely terrifying as breast cancers always tend to pop up as newspaper headlines” says Dr. Wickramasinghe. “As parents it is reasonable for you all to panic during situations like that, but the proper medical attention and care will guide you to the safest treatment options, which can either be conservative, medical or surgical”
Not something to panic about
According to Dr. Wickramasinghe, puberty is defined as a period of transition from childhood to adulthood which involves physiologic, somatic and constitutional changes associated with further development of the internal and external genitalia and secondary sexual characteristics. Breast development is the initial stage of this step-wise evolvement and breast buds, from which breasts are developed to mature glands, during its transition, might present as small, firm, mass under the areolar (the dark area of the breast) especially in one breast initially.Often felt as a strange sensation or pain on one breast at a time, breast buds are not something to get alarmed about and don’t suggest any hormonal imbalances or cancers.
However, once family members come across this kind of a presentation they frequently try to feel it to see the progression or changes associated and this constant manipulation may result in soreness, giving rise to unwanted complications like infections and inflammation” he further mentioned.
Is there a need to undergo any medical tests or biopsies?
“Well, this actually depends on how your child presents and the stage of puberty she is experiencing. After listening to the history and carrying out a thorough physical examination, we can decide what this painful lump really is and whether it needs further evaluation.
There are situations which might need fine needle aspiration biopsy etc. to come to a definitive diagnosis, but as I mentioned earlier, in a majority of girls around the age of 8-10 years- it is a mere breast bud which grows up during the normal breast development process of a girl.Adding to this, there was a condition known as Filariasis, which we used to see decades back which presented with a similar picture, but it is extremely rare now” Dr. Wickramasinghe explained.
Are there any other conditions which can mimic a breast bud but could be potentially dangerous?
Yes of course. There can be several other conditions which may present with a similar clinical picture, but almost all of them will come up after a girl reaches her puberty-meaning post pubertal, which should definitely be addressed by a qualified health care professional.
Breast cyst Cysts are small pockets comprising body tissue filled with air or fluid which can develop within the breast, often as a result of the blockage of glands.
Breast cysts are usually found in middle aged women, but may see in adolescent girls, who have attained puberty. The cysts can have an abrupt onset and can swell and be painful just before menstruation.
This is a situation which needs medical attention and if a cyst filled with pus is diagnosed, it can be treated with aspiration.
Fibroadenomas- These are benign lumps on the breast which can occur at all ages, but commonly seen in women between 16 and 24. The lump will be solid, smooth, firm and rubbery on touching and may grow up to various sizes.
It is better to visit a doctor if you find this kind of a lump on your child’s breast and it would be diagnosed through mammogram, ultrasound or fine-needle aspiration.
Breast abscess- Breast abscesses usually occurs in lactating mothers, but can occur in preadolescent girls too. It will be red and painful to touch. These abscesses usually develop as a result of an infection due to Staphylococcus aureus and the treatment will be needle aspiration and antibiotics
Benign fibrocystic changes
Over half of all women will experience fibrocystic changes in their breasts over their lifetime.
These lumps can result in pain and discomfort and medical advice is indicated if the mass doesn’t seem to disappear over a period of time.
In addition to all these conditions, a cancerous growth in breasts during childhood can be seen rarely and at times as a secondary deposits from a distant organ such as bone and therefore as health care professionals we always advice parents to bring their child to the hospital if the slightest changes are noted. This is to ensure that we can examine the child and decide whether she needs further evaluation or if it’s just a normal change occurring with the growth.
According to Dr. Wickramasinghe, if your child presents with any of the following signs in addition to the breast lump, she should get medical advice from a healthcare professional in order to see if any additional interventions are required.
- The lump isn’t situated directly under the nipple.
- The lump has a diameter more than 1.5 inches (4 cm).
- The lump doesn’t go away after 2 years.
- The lump occurs when the girl is over 15 years, especially couple of years after reaching the puberty
- The lump is attached to the chest wall, feels hard or is unmovable.
- Dimpled, ulcerated or discolored skin lying over the lump.
- Blood, milk or other discharge leaking from the nipples.
- If associated with other symptoms such as fever, night sweats or weight loss
Take home message:
“The human body is something really amazing. Most changes it under goes over the course of life time have still not been explained-as they are highly individualised and differ from person to person. So even if we generalize certain facts with data obtained by research studies, they may not be applicable to all the individuals-which is why we say, even though the medical information we share can apply to the majority-your child can be special or exceptional.
Having said that we always advise parents to seek right individual medical attention when an issue arises rather than seeking solutions on the internet or going to the pharmacy and get some medication prescribed for your friend’s kid for a similar health problem” highlighted Dr. Wickramasinghe.
