Breast Development in Females
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 breast growth took around four years. As a result, some girls may not complete breast 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 breast development into five stages that occurred during the four-year period. The first menstrual period often began in Tanner breast stage 4, shortly after the skeletal growth spurt and about two and one half to three years after the breast 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 breast 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 breast 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, breast 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 breast augmentation can be performed in certain cases, but this more than likely would be done after adolescence is complete.
In some cases, one breast is smaller than the opposite breast, and this causes an asymmetric appearance. Up to twenty-five percent of women have a persistent visible breast asymmetry. A clinician should evaluate this, although breast 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 breast sel-examinations BSE). About eighty percent of breast 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 breast 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 breast 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 breast 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.
Related topics:
Athletic injuries, back pain, body image, breast reduction surgery, breast self-examination, cosmetic surgery, exercise, growth and development, hair removal, self-esteem, sports
