14-year-old noticed lumps in her breast

My 14 y.o. daughter recently noticed breast lumps and we went to her pedicatrician. I can see based on the pediatrician's commments when I first called, and at the appointments that she (the pediatrician) has decent amount of experience with this and generally I find her quite good. In our case, we went back 3 times as doctor wanted to check at a different times in the cycle. Third time found no ''lumps'' but something she described as stringy in different locations than the initial lumps. Pediatrician is confident my daughter has fibrous breast tissue, and no need to worry about current stringy spots. She feels we should let it go unless a persistent or growing lump appears. She is willing to refer to specialist if we want, but doesn't recommend it and feels it would be unwarranted intervention at this time. I'm wondering if we should go to specialist to get further input/education and look into getting an ultrasound just to have a baseline (analogous to 40 yo or 50 yo mamogram baseline, but really I have no idea if this analogy makes sense). I am a little concerned that now that my daughter has received assurances from the doctor she will not be as attentive as maybe she should be about checking her breasts and reporting possible lumps. Please pipe in if you have experience or knowledge about care for teens with fibrous breasts. Thanks. anon

Here are the official NCI stats by age group. SEER breast cancer Incidence From 2003-2007, the median age at diagnosis for cancer of the breast was 61 years of age. Table I-11 (http://seer.cancer.gov/csr/ 1975_2007/results_single/sect_01_table.11_2pgs.pdf). Approximately 0.0% were diagnosed under age 20; 1.9% between 20 and 34; 10.5% between 35 and 44; 22.6% between 45 and 54; 24.1% between 55 and 64; 19.5% between 65 and 74; 15.8% between 75 and 84; and 5.6% 85+ years of age. The overall age-adjusted incidence rate was 122.9 per 100,000 women per year. So your daughter has a 0.0% chance out of the 123 women per 100,000 who are likely to get breat cancer. Of course the 0.0 figure is rounded so it is not absolute zero but it is very close to that.

Ultrasound is useful in distinguishing between cysts (fluid filled sacs that are not associated with cancer) and solid masses in the breast tissue of older women. I don't know if there is any information on its efficacy in a 14 year old. Becasue of the denser breast tissue in a 14 year old, the imaging may be poor.

Many younger women have fibrous or stingy breast tissue. It is nothing unusual. As a woman ages the breast generally gains fatty tissue. One reason mammagraphy is not used on younger women is becasue they have denser breast tissue (less fat) and the x-ray images are less clear and therefore less helpful. The other reason is that breast cancer occurs far more often in older women than younger. Sean

18-year-old's inverted nipples

My 18 year old daughter has told me that she has inverted or flat nipples and this was confirmed by her pediatrician. While the pediatrician told her there was no need to be concerned, she is very unhappy about this. I think she tried a mail order product to pull out the nipples (don't know which product) but without success. She is now considering plastic surgery for her nipples. I am appalled by this consideration as the surgery can affect the possibility of sucessful breastfeeding later in life, not to mention the cost and what it means in terms of body acceptance. She will coming home from college soon and we will be discussing this. I am wondering if anyone has dealt with this issue themselves or with their teen. Specifically I am wondering if anyone knows about a non-surgical product that has been successful in bringing out inverted nipples permanently. I have read about a product called the Avent Niplette but don't know anyone who has tried it or its efficacy. Also, does anyone know any great books or articles about body acceptance especially ones that might address this issue? Lastly, has anyone ever had this surgery or know someone who did? I know teens do not like to look differently than their peers but plastic surgery seems like a pretty drastic measure. Thank you for your feedback! anonymous

-Correction of inverted nipples.
-Usefulness of the nipple-suspension piercing device after
correction of inverted nipples.
-Correction of the inverted nipple with an internal 5-point
star suture.
-Correction of congenital nipple inversion with bilateral
rhombus deepithelialized subcutaneous pedicle skin flaps
and continuous traction.

I think you are overreacting to the idea of surgery since this is probably a VERY minor surg. We are not talking about a face lift. You state that, ''the surgery can affect the possibility of sucessful breastfeeding later.'' Does the medical literature actually back your assertion up? If this is a possiblility, what percent of patients have this unfortunate side effect? 0.4%, 65%? Also, how is breast feeding affected by leaving the nipples inverted? Does the inversion make it difficult for the infant to grasp the nipple to begin feeding? Do inverted nipples pop out when the breasts are engorged with milk? What are the typical psychosexual effects on women with this condition? Extreme embarrasment? Abnormal avoidance of normally desired sexual situations? I don't know, but a 15 minute consultation with a plastic surgeon should answer these questions.

From the few jour. article abstracts I did read, the problem is not pulling the nipple out, it is KEEPING it out. You seem to be under the mistaken impression that once the nipple ''pops'' out, it is fixed. I'm sure your daughter can grasp her nipple with her fingertips and simply pull it out. Problem is, it doesn't stay. This is caused by the anatomical anomaly of having too little supporting tissue beneath the nipple. That's why surg. is necessary.

I would suggest you force yourself to take as neutral a role in your discussions about this fairly common condition with your daughter as you can. Educate and support, don't judge. I think you really owe it to your daughter to at least discuss this with one or two plastic surgeons. Sean