Due to the obvious psychological changes that occur during adolescence, such as rebellion, shyness and blindness, and the fact that children at this stage are not aware of breast diseases, may not recognize their own diseases or are too shy to talk about them, they need relevant scientific education, publicity and counseling from medical staff and faculty. Common breast diseases in adolescence include: Chen Mianling, Department of Nail and Breast Vascular Surgery, Guangzhou First People’s Hospital
Fibroadenoma of the breast.
The female breast is one of the components of the endocrine system. When girls reach a certain age (after menstruation), the hormone level in the body is high and not very stable, and the fibroblasts in the lobules of breast tissue are more sensitive to estrogen and progesterone, fibroadenoma can occur at this time (1). It has also been reported that breast diseases are part of systemic endocrine disorders (2), or are related to genetic changes, the effects of certain drugs, or certain viral infections (3, 4, 5).
The age of high incidence of mammary fibroadenoma in adolescence is 15 to 18 years (6). With early detection and treatment, the rate of malignancy is extremely low, but if left untreated, they can gradually increase in size and, in the most severe cases, can even destroy the entire breast. Fibroadenomas after menarche all occur in small adolescent breasts, which clinically occupy almost the entire breast with highly tense skin, and are easily misdiagnosed as breast sarcoma.
This disease should be given high priority by families and educators. It is important to educate children about the disease, to develop good habits, to exercise in moderation, to choose appropriate bras for developing girls, to pay special attention to rest and sleep before and after menstruation, to rationalize diet, and to eat less plants and animals that rely on high doses of hormones. The first choice for examination is ultrasound without radiation damage, and surgical removal of mammary adenomas is a good method that is both economical and practical.
Mammary hyperplasia
Mastocytosis is caused by an increase in the level of estrogen in the body, resulting in hyperplasia of the terminal ducts and alveoli of the glands in the breast tissue and the surrounding fibrous tissue, with lymphocytic infiltration. Adolescent mastocytosis is generally caused by endocrine imbalance due to mental stress, academic pressure, and overwork, which inhibits ovulatory function of the ovaries, resulting in a decrease in progesterone and a relative increase in estrogen leading to mastocytosis. The clinical manifestation of adolescent breast hyperplasia is characterized by breast pain, mostly bilateral, but also unilateral pain, swelling and vague pain in nature, aggravated by premenstrual period, and more pronounced after emotional changes and exertion. Unlike adults, breast nodules are rarely present.
The presence of these problems requires prompt medical attention for physical examination and ultrasound. Treatment measures include: 1. Maintain emotional stability and reduce mental stimulation. School, family and hospital cooperation is needed to enable children to maintain a soothing mood and optimism; 2. lead a regular life, exercise appropriately, combine work and rest, get enough sleep, reduce late nights, and perform exercises to enhance breast fitness such as running and breast expansion; 3. adhere to daily breast massage to increase blood circulation in the breast; 4. avoid the use of drugs containing hormones and the use of beauty products; 4. eat a light diet. Eat more green leafy vegetables and fresh fruits, and reduce the intake of high-fat food; 5. If necessary, Chinese medicine should be used.
Multi-mammary deformity
Multiple nipple multiple breast deformity, also known as paramecium, is a congenital developmental abnormality Ying Qi. Under normal circumstances, except for the pair of mammary glands in the anterior chest area located between the fifth ribs, which can continue to develop to form mammary glands, the rest are atrophied and disappear. If one or more of the remaining pairs of mammary glands do not disappear, an extra breast or nipple is formed, which is called a paramammary gland. They can be a single pair, or a single pair or more, and are commonly found in the business or in the chest near the armpit, forming a localized bump like a lump. Some people can also experience periodic swelling and pain during menstruation.
Treatment: Parametrial gland is a common congenital malformation, asymptomatic people do not need treatment and should avoid causing psychological burden. Adolescent patients can be observed and followed up if it does not affect the aesthetics and daily life. If the size is large and affects aesthetics and daily activities, it can be surgically removed (6).
Breast dysplasia
In girls, breast development begins at the age of 12-13 years, and the breasts are basically mature by the age of 15-17 years. Despite ethnic and racial differences, the breast is roughly made up of 15-20 glandular lobes. Breast dysplasia is essentially a lack of tissue. Breast dysplasia is a congenital disorder in which there is a lack of glandular tissue but the skin is still intact and elastic. It occurs unilaterally and is often associated with pectoralis major hypoplasia or agenesis. In bilateral cases, it may be due to insensitivity of the breast tissue to sex hormones during maturation. Nipple development may be normal.
Clinical manifestations: 1. flat breasts without curvilinear features; 2. less obvious glandular tissue on palpation; 3. unilateral occurrence, left and right asymmetry; 4. may be accompanied by ipsilateral pectoralis major hypoplasia or orthopedia.
Treatment: 1. Psychological counseling: educate the patient to understand the disease, explain the causes and prognosis of the disease, so as to reduce the fear and anxiety of the disease; 2. Timely check the level of sex hormones in the body, understand the endocrine system for any disease, and make corresponding treatment; 3.
Inverted nipples
Most adolescent nipple invagination is a primary nipple deformity. The causes include: 1, the nipple and areola smooth muscle dysplasia: the nipple has the opening of the milk ducts, smooth muscle fibers around the milk ducts, and the nipple is pulled inward by the muscle fiber bundle around the milk ducts and inserted into the dermis of the nipple; 2, the milk ducts themselves are underdeveloped: the underdeveloped milk ducts fail to ductalize as strips and pull the nipple downward; 3, the lack of sufficient supporting tissue under the nipple is also a cause of nipple The lack of sufficient support tissue under the nipple is also a cause of nipple invagination; 4. Too tight clothing during adolescence can easily lead to nipple invagination.
The adverse consequences of nipple invagination include: 1. Nipple invagination can easily cause inflammation of the nipple areola and eventually lead to mastitis, breast abscesses and other diseases: long-term nipple invagination compresses the lymphatic vessels behind the areola, leading to impaired lymphatic flow and collagen tissue exudation, while, due to nipple invagination, the epidermal cells and areolar secretions shed on the nipple surface cannot be removed in time to stimulate the nipple skin, causing inflammation of the nipple areola. Severe nipple invagination leads to mucosalization of the invaginated skin with eczema, and in some patients, bleeding and erosion, forming chronic inflammation. The ducts of the breast are connected to the invagination and the inflammation can spread retrograde infection into the breast, causing mastitis. If the nipple is not corrected in time, the inflammation is stimulated for a long time, resulting in the contraction of the breast ducts due to chronic inflammation, the nipple inversion is more serious, easily forming a vicious circle.
2, nipple invasion seriously affects breastfeeding: nipple invasion, will inevitably affect the newborn’s containment and sucking, so that after the birth of breastfeeding difficulties, or unable to breastfeed; 4, affect the beauty of the breast: nipple invasion is detrimental to the beauty of women’s breasts, losing the proper curve, affecting the beauty of the breast; 5, affect sex life: nipple is a very important sex sensitive point for women, many women’s sexual desire is stimulated through the nipple to reach The. Once the nipple is sunken, it is difficult to play an effective sexual stimulation, and even affect the male partner’s sexual desire; 6, affect the patient’s psychological health: long-term anxiety, worry and lack of confidence in their own bodies, seriously affect the psychological health of women.
Prevention: 1, adolescent developmental underwear should be cotton products, and frequent changes, sunlight exposure. If the nipples show signs of redness and fissures, underwear should be steamed and disinfected, and bras should not be used prematurely; 2. Prevent chronic squeezing. Underwear and bras are appropriate, not too tight, and for girls with larger breasts, more attention should be paid to the looseness of the breasts, and for girls with prone habits, they should be corrected in time to prevent the nipples from being squeezed, so as not to aggravate the degree of nipple invagination. Treatment: Non-surgical treatment: (1) pulling method: in the process of breast development, wash your breasts with warm water every morning and evening, then use your fingers to gently pinch the sunken nipple and slowly pull it outward, while pulling, use the thumb and forefinger of the other hand to gently massage the nipple and do it for 5-10 minutes each time; (2) attraction method: a syringe jacket tube can be used over the nipple part. You can also use a small wine goblet to hold the nipple, plus a cloth belt to compress, or use a cupping pot to suck outward, but also plastic cans can be pinched flat and then buckled around the nipple, let go of the hand also has suction, also play the role of cupping; (3) unarmed pull: for mild nipple depression and those who can squeeze out the nipple, you can use your hand to pull. Pull several times a day, each time to more than half an hour, over time, you will see the effect. And this method is economical, simple and convenient. However, continuous pulling tends to make people tired and unable to hold on for a long time, thus affecting the effectiveness of the treatment (7). The aim of surgical treatment is to ensure good nipple shape, stability of the result, and to enlarge the nipple. Correction of nipple invagination with preservation of the milk ducts is usually performed by the flap method. However, non-surgical treatment is recommended during adolescence.
Male breast development
The etiology of mammary gland development during puberty is mostly due to excessive estrogen or insufficient androgens. In addition, pituitary adenomas, thyroid disorders, adrenal cortical disorders, testicular tumors, and liver disorders can cause male breast development.
Male adolescent breast development refers to the enlargement of one or both mammary glands due to the growth of mammary tissue during puberty, between the ages of 12 and 16. Persistence or more than 75px requires a hospital visit to check sex hormone levels and the presence of pituitary, adrenal, testicular and liver disease.
Treatment: No treatment is usually required during puberty, and most patients disappear on their own within 1 to 2 years of onset. If there are painful symptoms and low androgen levels, oral methyltestosterone can be administered. If significant hypertrophy affects the appearance, it can be surgically removed.
References
1, Zhao Yangbing, Chen Jie. Advances in the treatment of breast fibroadenoma, Journal of Clinical Surgery, 2007, 15(6): 369-371
2. Yin H-M, Shen J-S. Fibroadenoma of the breast in prepuberty, Chinese Journal of Pediatrics, 1998, 19(1):22-23
3, Rizou H, Bardi G, Arnaourti M, et al. Metaphase and interphase cytogenetics in fibroadenomas of the breast. In Vivo, 2004, 18(6):703-711
4, Seo YL, Choi CS, Yoon DY, et al. Benign breast disease associated with cyclosprin therapy in renal transplant recipients. Transplantion Proc, 2005, 37 (10):4315-4319.
5, Tsai JH, Tsai CH, Cheng MH, et al. Association of viral factors with non-familial breast cancer inTaiwanby comparison with non-cancerous, fibroadenoma, and thyroid tumor tissues. J Med Virol, 2005, 75(2):276-281.
6. Chen Xiaoping, ed. Surgery, People’s Health Press, 2012: 438
7. Ma Ying, Yan Xiao Xue, Zhao Xiao Li, et al. Non-surgical and surgical treatment of nipple invagination, Chinese Aesthetic Medicine, 2009, 10(20):56-59