Breast development and disorders in the adolescent female

Sisters But Not Twins: A Critical Appraisal of Long-Term Results in Breast Asymmetry Correction

BACKGROUND

Breast asymmetry is a common disorder, which can lead to significant emotional distress. Despite this, there is currently no widely accepted approach for managing this prevalent condition. Due to the high dimorphism of the breast, despite a satisfactory result in the short-term post-op, the recurrence of asymmetry is one of the most common weak points of breast recontouring. The purpose of this paper is to investigate the long-lasting maintenance of breast symmetry in women who have undergone surgical correction of asymmetric breasts through mastopexy or reduction mammoplasty and to try to identify some specific elements to achieve more stable outcomes in the long term.

METHODS

A retrospective study was conducted on 1,984 breast surgical procedures carried out between 2002 and 2020 to evaluate patient satisfaction and the recurrence rate of asymmetry disorders. All the patients enrolled in this study were given a questionnaire to evaluate their satisfaction level. A retrospective iconographic-chart review was investigated by the same senior surgeon, who recorded the presence or the absence of recurring breast asymmetry.

RESULTS

In total, 1984 patients were enrolled who respected the minimum standard of the study; 596 showed up at post-op follow-up longer than three years. Most of the patients showed great satisfaction with the results, even if several recurrences of asymmetry were reported.

CONCLUSIONS

The recurrence of asymmetry is one of the most common weak points of breast asymmetry correction procedures due to the high dimorphism of the breasts. In order to fully assess the results of asymmetric breast correction, patients should be required to attend a post-op follow-up examination after a long time frame. Indeed, the strength of this paper lies in the focus on long-term postoperative follow-up.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Optimal strategies for addressing developmental breast asymmetry and the significance of symmetrical treatment: A systematic review

BACKGROUND

Approximately one quarter of women are affected by asymmetry as a result of abnormal breast development, which can lead to significant emotional distress. Despite this, there is currently no widely accepted approach for managing this prevalent condition. This systematic review aimed to review the available literature on the management of developmental breast asymmetry.

METHODS

A comprehensive search in MEDLINE, EMBASE, and CENTRAL databases was conducted for primary clinical studies reporting on the management of developmental breast asymmetry from 1962 to November 2022. The primary outcome measures were long-term aesthetic outcomes and patient-reported outcomes.

RESULTS

Eleven case series and 2 cohort studies were included, comprising a total of 1237 patients with a mean age of 26.5 years (range 14-65 years). Twelve studies (92%) addressed asymmetry through surgical means, using various augmentation and reduction procedures, whereas one study (8%) utilized external prostheses. Meta-analysis of the data was not deemed to be possible because of heterogeneity of data; a narrative synthesis of the literature was provided.

CONCLUSIONS

There is no consensus on how to manage developmental breast asymmetry. Furthermore, there is a lack of consistency in the classification of patients with developmental breast asymmetry and in the reporting of outcomes, highlighting the need for a consensus. Further research outlining long-term aesthetic and patient-reported outcomes is needed to understand which procedures provide optimal outcomes. In addition, external breast prosthesis is a promising nonsurgical alternative, and further studies into its efficacy are needed.

Breast development and disorders in children and adolescents

Breast masses are infrequently encountered in pediatric and adolescent populations. Most breast masses in children are benign entities arising from embryological defects which can be managed once breast development is complete. Diagnostic and management dilemmas arise when fibroepithelial lesions of the breast are seen in clinical practice. Differentiation between a fibroadenoma and a phyllodes tumor is important to guide management. Breast cancer in children under 18 years of age is extremely rare and invasive diagnostic testing and aggressive management is only recommended when clinical suspicion of malignancy is very high. Patient and caregiver counseling plays an important role in the management of these diseases. While adult-onset breast diseases have been studied very closely, there is a dearth of literature on pediatric breast anomalies. This review aims to provide a scoping overview of the available literature on benign, fibroepithelial, and malignant lesions of the breast in pediatric and adolescent populations to help guide physicians and surgeons with decision-making regarding the diagnosis and management of pediatric breast diseases.

Changes to breast structure and function across a woman's lifespan: Implications for managing and modeling female breast injuries

BACKGROUND

Female breasts change throughout a woman's life in response to fluctuating hormonal influences. Individuals managing active women and those modeling female breasts must understand these structural and functional changes across a female's lifespan because these changes affect breast injuries sustained by women.

METHODS

We initially review female breast structure and function and then describe how breast structure changes across a woman's lifespan. Key studies about direct contact and frictional breast injuries are then summarized. Limitations of current breast injury research, gaps in knowledge about breast injuries incurred by specific populations, and the lack of breast injury models are also highlighted.

FINDINGS

With minimal anatomical protection, it is unsurprising that breast injuries occur. Although research about breast injuries is scant, direct contact during blunt force trauma to the anterior chest wall and frictional breast injuries have been reported. There is a lack, however, of research documenting the incidence and severity of breast injuries incurred in occupational settings and in women's sports. Therefore, to design effective breast protective equipment, we recommend research to model and investigate the mechanisms and forces involved in breast injuries, particularly injuries sustained during sport.

INTERPRETATION

This unique review summarizes how female breasts change over a woman's life span, with implications for breast injuries sustained by females. Knowledge gaps about female breast injuries are highlighted. We conclude by recommending research required to develop evidence-based strategies to improve how we classify, prevent, and clinically manage breast injuries sustained by females.

SUMMARY

We review changes to the breast across a woman's lifespan, highlighting implications for managing and modeling female breast injuries.

Impact of right anterolateral thoracotomy with a new approach on breast development: survey analysis of female cardiac surgery patients

INTRODUCTION

Our aim was to present the effects of submammarian thoracotomy by our new approach to breast development in young female patients between 8 and 14 years old.

METHODS

Atrial septal defect closure was performed in 55 female patients between 8 and 14 years old at the time of operation between January 2010 and January 2018 by median sternotomy or right anterolateral thoracotomy. These patients were called for a follow-up visits, breast examination were performed, and a questionnaire of 10 questions was applied.

RESULTS

According to the answer given by the patients to the question of "how would you describe your scar" showed that the surgical method satisfies all patients cosmetically in study group. The overall satisfaction rate for the cosmetic results of operation was 100% versus 41.1%, respectively. The percentage of patients said no to the question "Do you experience lack of self-confidence related your scar" was significantly higher than the control group (p < 0.001). The percentage of those who said yes to the question "Would you like to be operated with the same approach if you will have surgery again?" in the study group was significantly higher than the control group (p = 0.002).

CONCLUSIONS

We consider that our procedure is safe and effective with improved cosmetic results compared to median sternotomy which also confers many advantages such as less trauma, less pain, faster recovery, and shorter hospital stay. This study presents one of the largest series of paediatric patients operated by submammarian thoracotomy.

“I’m walking on eggshells”: challenges faced by mothers with breast cancer in interacting with adolescent daughters

Background

With breast cancer becoming the most diagnosed cancer in the world, the number of breast cancer-afflicted mothers with adolescent daughters is also rising. Further, adolescent daughters’ mothers serve as role models for in identity formation processes, especially concerning gender and sexuality. Nevertheless, breast cancer threats mother’s health, including such a key symbol of her womanhood—the breast—which may adversely affect the development of an adolescent daughter’s own sense of personal identity and womanhood. However, few researchers and practitioners have paid attention to mother-daughter interactions in the context of breast cancer. Therefore, this study aimed to uncover the nuances of the interactive challenges with adolescent daughters from breast cancer-afflicted mothers’ perspective.

Methods

We conducted a qualitative study following the sample saturation principle, collecting data through semi-structured interviews with 21 breast cancer patients who met the inclusion criteria. We utilized thematic analysis and partially integrated the Foucauldian discourse approach to analyze the data.

Results

Three major themes emerged from the data: (1) mothers are lost in chaos (inability to handle the shock of cancer, feelings of powerlessness about the uncertainty of their life span, and confusion about how to respond to daughter’s curiosity); (2) mothers struggle to maintain balance (torn between protecting daughters and letting them be independent, and making a tough choice between being a mother or a patient); and (3) mothers are immersed in guilt (increasing daughters’ risk of cancer, influencing daughters’ development, and imposing burdens on daughters).

Conclusions

Our research explored the interactive experience of breast cancer-afflicted mothers and adolescent daughters. The insights uncovered by this study will help mothers enhance interaction with their daughters and assist health practitioners in devising interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01872-1.

Breast development in pediatric patients from birth to puberty: physiology, pathology and imaging correlation

Breast tissue undergoes a series of changes from birth to puberty. The majority of the changes are transient, related to physiological hormonal changes. Although the breast is identical in both sexes at birth, its histology and development will eventually differ. It is important for radiologists to have a basic understanding of endocrinological changes and appearance on imaging to avoid potential pitfalls, particularly on ultrasound, which is the primary modality used to evaluate the breast.

Clinically Malignant Breast Lesion in an Adolescent Girl: A Case Report

Diseases of the breast in adolescent women are usually benign, and their treatment is simple using appropriate medical strategy and rarely surgical therapy. The whole team’s real challenge is when the girl presents malignant breast cancer symptoms such as a non-movable tumor, nipple discharge, nipple retraction, retraction of the skin, inflammatory infiltration of the breast, or ulceration. Presented here is a case of a 15-years-old girl with the features of a malignant neoplasm of the breast. There was an observed non-movable tumor, retraction of the nipple, inflammatory infiltration, and pain. The performed ultrasound and magnetic resonance imaging suggested a malignant lesion measuring 84 mm × 66 mm × 50 mm. After many diagnostic difficulties, the lesion evacuated spontaneously, and the abscess was diagnosed. In conclusion, not all features of a malignant breast tumor in adult women are typical for adolescent females. In young girls, breast diseases are usually benign, and appropriate diagnostics and therapy allow for an effective cure. Atypical breast lesions require the extraordinary cooperation of a multidisciplinary team.

Modern, exogenous exposures associated with altered mammary gland development: A systematic review

BACKGROUND

Many women report low milk supply as the reason for premature breastfeeding cessation. Altered mammary gland development may impact a woman's lactation ability.

OBJECTIVE

This review identifies modern exogenous exposures which alter mammary gland development during embryonic life, puberty and pregnancy.

METHODS

A systematic review was undertaken whereby Medline, CINAHL and Embase articles published from January 1, 2005 to November 20, 2020 were searched using the keywords puberty or embry* or fetal or foetal or foetus or fetus or pregnan* or gestation* AND "mammary gland development" or "breast development" or "mammary development" or "mammary gland function" or "mammary function" or "insufficient glandular tissue" or "mammary hypoplasia" or "breast hypoplasia" or "mammary gland hypoplasia" or "tubular breast*" or "tuberous breast*" or "glandular tissue" or "breast composition" or "mammary composition" or "mammary gland composition". After initial screening of 1207 records, 60 full texts were assessed for eligibility; 6 were excluded due to lack of information about exposure or outcome, leaving 54 studies.

RESULTS

The review included results from 52 animal (rats and mice, monkeys, rabbits, sheep, goats pigs and cows) and 2 human studies. Various endocrine disrupting chemicals and an obesogenic diet were found to be associated with altered mammary gland morphology during key development stages.

CONCLUSIONS

To improve lactation outcomes, future studies need to focus on lactation as the endpoint and be conducted in a standardised manner to allow for a more significant contribution to the literature that allows for better comparison across studies.

Breast pathology in adolescence

OBJECTIVE

Description of breast pathology in adolescents.

METHODS

A retrospective descriptive study of adolescents who were referred to the Gynecology consultation of a tertiary pediatric hospital for suspected breast pathology, in the period from the 1st June 2011 to the 30th December 2018.

RESULTS

One hundred and two female adolescents (11 to 18 years old) with suspected breast pathology were referred (6% of the motives for consultation), with confirmation in 58 (56.9%), who were included in the study. The reasons for referral were breast masses (66%), anomalies in breast size or symmetry (29%) and infection (5%). Of breast masses, the most frequent diagnosis was fibroadenoma (76%), followed by fibro-cystic pathology (18%). In most cases, a conservative approach was chosen, with clinical and imaging surveillance. Surgery was required in 29% of these cases. Anomalies in breast size and symmetry were observed in 17 adolescents. Two adolescents were submitted to symmetrization, after 18 years of age. Infectious and inflammatory pathology occurred in three cases: two mastitis and one retroareolar cyst. The approach consisted mainly of antibiotherapy. There were no cases of malignant breast disease.

CONCLUSION

Lumps or breast masses are the most frequent breast pathology in adolescence, and in the majority of cases surveillance was recommended, as they are a mere sign of hormonal oscillations at this age. Objective examination and/or breast ultrasound are usually enough to make the diagnosis. The approach must be mainly conservative, since malignancy is extremely rare in this age group.

Proposed hypothesis and rationale for association between mastitis and breast cancer

Breast cancer is amongst the most common forms of cancer, is predominantly a woman's illness, and is the most frequently reported invasive cancer in women worldwide (Bray et al., 2018). Varying risk factors have been identified, including genetics, family history, lifestyle, age and the use of hormone replacement therapy. Mastitis, also predominantly a woman's illness, is an inflammatory condition of the breast that, despite being an inflammation-related condition, is not currently considered a risk factor for breast cancer. This appears counterintuitive as epidemiological studies have identified chronic inflammation as a contributor to cancer risk, for example in gastric, oesophageal and colon cancers (Lin et al., 2016; Qadri et al., 2014; Principe et al., 2017). Previous reports have focused on women hospitalised for mastitis, and most commonly on puerperal mastitis, perhaps underestimating the relationship between breast cancer and non-lactational mastitis. Our hypothesis, based on systematic review, suggests that a longitudinal study of this disease, affecting women predominantly, is warranted.

Surgical management of giant juvenile fibroadenoma with skin reducing tumor resection and immediate breast reconstruction: A single-center experience

BACKGROUND AND OBJECTIVES

Giant juvenile fibroadenoma (GJF) is a rare benign tumor that disfiguring affects the breast shape and quality of life of patients. This study aimed to report the experience of GJF management.

METHODS

A Wise-pattern skin reducing tumor resection followed by immediate breast reconstruction with a dermal flap pocket was used. The long-term outcomes were assessed retrospectively by BREAST-Q questionnaire from 2008 to 2018.

RESULTS

The study included eight patients with GJF. All patients achieved satisfactory results without severe complications. The BREAST-Q revealed that postoperative scores for satisfaction with breasts (69.3 ± 17.6) and sexual wellbeing (62.3 ± 27.6) were higher than the normative scores. The psychosocial wellbeing (69.7 ± 14.6) and physical wellbeing-chest (86.8 ± 13.0) scores were slightly lower than the normative scores.

CONCLUSION

Although GJF is a benign tumor, it should be surgically removed. And the Wise-pattern skin reducing tumor resection with immediate breast reconstruction is a proper way to improve patients' satisfaction with breast size and shape and quality of life.

The female adolescent breast: disorders of development

PURPOSE OF REVIEW

This article will provide an overview on female breast development and focus on common abnormalities of growth, the emerging role of breast self-awareness, and discuss trends in the evaluation and treatment of the breast masses and disorders most often encountered in the female adolescent population.

RECENT FINDINGS

Although the embryology of breast development is unchanged, data are emerging on the role of environmental factors on the timing of puberty and thelarche. As breast development occurs, the role of breast self-awareness is also a new trend that allows teens to be cognizant of changes in their own breast and to become more comfortable with their own anatomy. Finally, when breast treatments are needed or desired, the timing of breast treatments is a subject that must be individualized.

SUMMARY

There are numerous conditions that can result from disruption of normal breast development. These resultant breast disorders are generally benign but can still cause emotional distress to both the patient and family. It is thus imperative that healthcare providers be educated on breast development, the common breast masses that occur in the adolescent population and be prepared to discuss breast self-awareness and shared decision-making in this population.