Breast DevelopmentBy JACOB of Bigplanners.com
The earliest sign of pubertal development in up to ninety-two percent of white females
is development of the breast. Growth, development and enlargement of the breasts in girls is due
to exposure to increasing levels of the female hormone estrogen; breast development may start as
early as eight years or as late as thirteen years.
In 1969, Marshall and Tanner studied 192 English schoolgirls, and from this study, they were
able to define and delineate the Sexual Maturity Rating scale for girls.
Besides finding that
the initiation of breast development occurred between nine and thirteen years, they also
determined that the completion of growth took around four years. As a result, some girls
may not complete growth until age seventeen or eighteen years if they begin at thirteen
years.
Breast development often begins on one side before the other. One may notice a tender firm lump
underneath the nipple. While startling to some girls, more than likely this lump represents the
“bud” of
breast development. Marshall and Tanner were able to categorize development into
five stages that occurred during the four-year period. The first menstrual period often began in
Tanner stage 4, shortly after the skeletal growth spurt and about two and one half to
three years after the bud stage.
Subsequent to the seminal studies from Marshall and Tanner, a large study of seventeen thousand
girls that was conducted by community pediatricians noted some differences in the onset of
development. For girls between age eight and nine years, five percent of white girls and 15.4%
of African American girls had some breast development. It is generally considered that
development in girls prior to the age of eight years is precocious and will necessitate a
medical evaluation. And girls who have not begun to develop breasts by age thirteen years may
also need a medical evaluation.
Girls who lack
breast development may have absence of the glandular tissue. This
condition is exceedingly rare. Or they may have a chronic illness such as Crohn’s disease,
Turner syndrome or a severe eating disorder. Extra nipples or breasts may also occur in up to
two percent of healthy girls. These usually do not develop unless there is a pregnancy, but the
nipples may be seen along the milk line from the armpit to the thigh. Some girls elect to have
the extra tissue removed after her growth and development is completed.
Occasionally, a girl will develop very large and pendulous breasts. Large breasts may cause
backache, sore shoulders, psychological distress as well as kyphosis, which is a forward
curvature of the upper spine. In some cases, reduction surgery is recommended.
Other girls may have small breasts. If she is developing normally including having normal
menstruation, then a medical evaluation is not necessary. A augmentation can be
performed in certain cases, but this more than likely would be done after adolescence is
complete.
In some cases, one is smaller than the opposite breast, and this causes an asymmetric
appearance. Up to twenty-five percent of women have a persistent visible asymmetry. A
clinician should evaluate this, although asymmetry is not uncommon early on in
breast
development. Padded bras or simple bra pads may make the asymmetry less of a problem An
augmentation or reduction surgical procedure may be performed by a plastic surgeon to make the
breasts more symmetric after development is complete.
Girls may experience problems with their breasts during athletic activities. Joggers may notice
sore or scaling nipples due to the friction. A soft bra, lubrication or even a band-aid over
the nipples may be helpful. Exposure to persistent cold temperatures may cause some tenderness
over the nipples. Dressing for the weather with layers over the chest should be helpful. Girls
who have large and pendulous breasts may develop yeast infections in the undersurface of the
breast. Topical antifungal agents may help to eradicate the infection. Sports bras may be
helpful for girls with large breasts who participate actively in athletics.
Many girls develop some hair growth from the nipple and surrounding tissue called the areola.
It is recommended that the hair not be plucked since infections or ingrown hairs may occur.
Clipping the hair is usually advised.
Toward the end of breast development or by age sixteen years, girls should consider performing
period sel-examinations BSE). About eighty percent of masses are detected by the
adolescent patient. BSE helps to familiarize the adolescent with the feel of her normal breasts,
promotes a sense of responsibility for self-care and helps to form lifelong health habits.
While some adolescents may have some anxiety from BSE, the benefits to teens outweigh the
disadvantages and most clinicians who provide care to adolescents teach and encourage
adolescents to perform monthly BSE.
Breast Development in Males
Any
breast development in males is called gynecomastia. Around seventy percent of boys develop
breast tissue temporarily during adolescent growth and development. The male mammary gland is
very similar to that of the prepubertal female. During the male’s adolescent growth and
development period, a temporary hormone imbalance may cause the tissue to enlarge.
This usually
presents as a tender one sided firm lump often found by the male during self-examination.
The tissue is usually less than one inch in diameter. Often the teen asks to be evaluated by a
clinician, and sometimes the clinician will note the enlargement on a routine physical
examination.
No workup is usually done. If breast development occurs after an adolescent has
completed his growth and development, an evaluation is usually done. Fat may also give the
breasts an enlarged appearance. Weight loss and exercise should help to reduce the amount of
tissue.
Transient enlargement in boys usually lasts less than two years. Some boys are extremely
self-conscious about
breast development and have difficulties taking off their shirts in front
of other boys. It is helpful to know that the breasts usually recede on their own.
Occasionally
street drugs including marijuana will aggravate the condition. If the breasts are very large,
or do not recede spontaneously, then surgical reduction may be performed. Some boys may also
require counseling on self-image issues.
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