Breast and Chest Wall Disorders
What are breast and chest wall disorders?
Breast development begins in utero, before a baby is born. The stage of breast development associated with puberty typically begins between the ages of 8 and 13, but every child develops differently. If your child develops breasts earlier or later than average, that does not mean that she has a medical problem. Many breast differences are part of normal development in both boys and girls. Asymmetrical breast buds are very common, as are breast buds that come and go, and cysts of the breasts.
Breast disorders in children and adolescents can come from a variety of causes, some congenital and some acquired in nature.
Congenital breast deformities are present at birth. They may be evident when the child is born (for example, Poland syndrome where part of the chest wall muscle is missing), or may only become apparent in adolescence (for example, mammary hypoplasia or hyperplasia, or breast asymmetries). The cause of most of these disorders is unknown.
Breast deformities can also be acquired later in development, as a result of trauma, burns, tumors, surgery, infection or endocrine dysfunction.
Types of pediatric breast and chest wall disorders
- Breast masses
- Benign breast tumors, including fibroadenoma
- Breast cancer
- Vascular malformations
- Congenital anomalies of the breast and chest wall
- Polymastia and polythelia (extra breasts or nipples)
- Ectopic breast tissue (often in the axilla or armpit area)
- Nipple or areolar deformities
- Poland syndrome (missing chest wall muscle and breast tissue)
- Overgrowth of the breast in females
- Macromastia (overdevelopment of breast tissue)
- Juvenile hypertrophy / gigantomastia (drastic enlargement of one or both of the breasts that occurs in females during puberty)
- Gynecomastia (breast growth in males)
- Breast hypoplasia (undergrowth of the breast)
- Breast asymmetry
- Tuberous or constricted breast deformities
- Deformational disorders of the breast or chest wall related to:
- Trauma, burns and vascular malformations
- Conjoined twins
- Congenital scoliosis (in cases of severe scoliosis, thoracic insufficiency or conjoined twins, chest wall might be so asymmetric that breasts are displaced)
Evaluation and diagnosis
At CHOP, boys and girls with breast and chest wall disorders are diagnosed and treated through our Pediatric and Adolescent Breast Program. Through this program, your child will have access to experts that will treat all aspects of the condition.
Evaluation includes, when indicated, a full medical and endocrine evaluation, as well as evaluation by a psychologist when the breast condition has affected your child socially or psychologically. Comprehensive treatment for breast disorders in children addresses the functional, appearance-related and psychosocial aspects of the condition itself.
Many factors are considered when determining the best treatment plan for your child, including age, severity of the disorder, and psychosocial health.
Breast and chest wall disorders are commonly treated with surgery. The timing and type of surgery to treat breast and chest wall disorders depends on the needs of the individual patient.
Surgeries that are commonly performed include:
- Excision of breast tumors or masses
- Breast reduction surgery
- Surgery for breast asymmetries, including breast reduction surgery; breast augmentation with the use of tissue expanders and breast implants; and mastopexy to reshape the breast
- Surgery for breast and chest wall reconstruction, including placement of tissue expanders and breast implants; mastopexy to reshape the breast; or muscle, skin, or bone flaps
- Reconstruction of the nipple and areola
- Gynecomastia excision
- Revisions of the breast and chest wall secondary to trauma and burns which may involve scar releases, scar revisions, and the use of tissue expanders or local flaps