Finding a breast lump can be frightening, especially when breast cancer is already part of a family’s experience. The reassuring fact is that most breast lumps in children and adolescents are benign, meaning they are not cancer. Breast cancer at these ages is very rare.
That reassurance should accompany an evaluation. A new lump or unusual breast change is a reason to contact your child’s pediatrician.
Common causes of breast changes in children and teens
Breast development: Developing tissue can feel firm beneath the nipple. One breast may begin growing before the other, and differences in size are common.
Fibroadenomas: These benign growths are the most common benign breast lumps in children and adolescents. Some remain stable or disappear; others grow enough to need treatment.
Cysts and hormonal changes: Fluid-filled cysts and menstrual hormone changes can cause lumpiness, tenderness or fullness.
Infection or injury: An abscess may cause a red, tender lump. An injury can also produce a palpable area or blood collection.
A lump’s feel alone cannot establish its diagnosis at home.
When should a pediatrician evaluate a breast lump?
Contact the office for a new lump, a new change in breast shape, nipple discharge or unexplained pain. Tell the clinician if the lump is enlarging quickly, whether symptoms change with menstrual periods and whether there has been an injury.
Seek prompt medical care for a red lump with fever, bloody or pus-like nipple discharge, significant tenderness or a child who appears ill. Redness without fever should also be discussed promptly, generally within 24 hours. These findings can indicate infection or another condition requiring timely treatment; they do not automatically mean cancer.
What happens during an evaluation?
The clinician asks about symptoms and personal and family medical history, then examines the breast and nearby areas. Not every child needs imaging or a biopsy.
When imaging is needed, ultrasound is commonly used in young patients. It uses sound waves rather than ionizing radiation and can help distinguish a fluid-filled cyst from a solid mass. Mammography is generally not the first imaging test for a child’s breast concern.
Biopsy or specialist referral may be appropriate for a large, rapidly growing or otherwise concerning mass. The plan depends on the examination and imaging findings.
Why observation can be appropriate
After evaluation, a clinician may recommend monitoring a benign-appearing lump rather than immediate removal. Monitoring should include a follow-up plan and instructions about changes to report.
Some benign masses need surgery because they enlarge, cause symptoms or have uncertain features. Treatment is individualized, with attention to preserving developing breast tissue. “Benign” does not mean every lump follows the same course.
What about breast changes in boys?
Boys also have breast tissue. Puberty can cause gynecomastia—an increase in breast gland tissue that may feel tender or appear uneven. It often improves over time.
A clinician should assess a new lump or concerning change rather than assuming it is a normal puberty-related finding.
Does a family history of breast cancer change the advice?
Tell the pediatrician about relatives with breast or ovarian cancer, their ages at diagnosis and any known inherited cancer-related variants. Also share a child’s history of cancer or radiation treatment involving the chest.
A family history does not mean a teen’s lump is cancer. It helps guide individualized assessment.
Professional groups generally do not recommend BRCA1 or BRCA2 predictive testing before age 18 because these associated cancers are very uncommon in childhood and childhood-specific risk-reduction measures are not available. Other inherited syndromes can require different advice; genetic counseling can clarify the appropriate timing of testing and surveillance.
Help your teen ask for care without embarrassment
Thank your teen for telling you. Explain that puberty brings changes, that most adolescent breast lumps are benign and that an examination can help establish what is happening.
Before the visit, write down when the change began, whether it is growing, any pain or discharge and relevant family history. Avoid squeezing or trying to drain a lump. Encourage your teen to raise questions directly with the clinician.
If your child has noticed a breast lump or unexplained change, contact Sandy Springs Pediatrics to discuss an evaluation. Clear information and an appropriate follow-up plan can help families understand what comes next.