Breast Lumps

qabreast lumps
Q:
qabreast lumps

Dr. Greene, my 12-year-old son has a sore lump directly under his nipple. Could this be puberty related? This lump is tiny and hard and underneath the skin of the nipple. Thanks for your help!
Alberta, Canada

A:

Dr. Greene’s Answer:

Lumps of one kind or another are a common reason for a visit to the doctor’s office. The lump might be in the neck (that the parents suspect is just a swollen gland), in the knee (that the parents think is from sliding into third base last month), or under the nipple (that the parents hope is due to puberty). I often enjoy seeing parents with these concerns in my own office. Sometimes the parents feel that they shouldn’t even bother their doctor with this because it’s probably normal. But underneath these hopeful, at-home diagnoses lies a common fear–it might be a tumor!

Most lumps in children are not cancerous and are not serious. Thankfully, childhood cancer is uncommon. But parents’ fears are not unfounded. Childhood breast cancer is quite rare, but it certainly does occur, even in boys. In males of all ages, breast cancer accounts for less than 1% of all cancers (American Surgeon, 1999; 65:250–253). But if it is your son, any chance of cancer seems too much. And a lump might be the first sign noticed.

Breast lumps in children often give rise to two immediate fears–Could it be a tumor? Or could something be going wrong with puberty? (A third fear–Will my child be teased?–arises if the first two turn out to be no problem.)

I’ll give you some guidelines for when to be concerned about a breast lump and when you can relax.

Puberty is a time of dramatic changes in the body, especially in the reproductive system. These transformations are brought about by surges of complex and precisely balanced hormones. The last time your 12-year-old had these tides of hormones was when he was a newborn–but then the hormones were yours. Coursing through his blood, your hormones matured his lungs, made him ready for life in the big outside world, and along the way may have given him baby acne and breast enlargement–even nipples that leaked milk. This precious newborn season was gone in a blink.

Now your 12-year-old is making surges of these same hormones on his own as his body turns into an adult’s–a miracle not unlike when you helped turn his body into a newborn’s.

There are five stages of the changes that occur during puberty, called Tanner stages or Sexual Maturity Rating (SMR) stages. Breast lumps in boys are common during SMR 3 and SMR 4.

In boys, SMR 3 usually begins at about age 12 or 13 years and lasts a year or so, although it can be normal in our culture to begin as early as 10 years or as late as 14.9 years, according to Tanner (Journal of Pediatrics, 1985; 107:317). SMR 3 is the time when the testes get clearly larger, the penis gets noticeably longer (then thicker in SMR 4), and the pubic hair (though still small in amount) gets darker and starts to curl.

Sperm is first produced during SMR 3.

Boys grow at their fastest during SMR 3 and SMR 4 (girls get their growth spurts earlier). With your son, you’re probably seeing him outgrow his beginning-of-the-year school clothes already–especially his shoes. During SMR 3, the feet and hands usually grow first, then the arms and legs, and finally the trunk–giving them that adorable adolescent gawky look (don’t tell my 12-year-old son I said that).

SMR 3 also marks the beginning of significant underarm perspiration (the odor, as you’ve probably noticed, can start much earlier).

And teenage acne usually begins at SMR 3, continuing on until the end of puberty.

In newborns, baby acne and breast buds often occur at about the same time. In the same way, many adolescent boys develop gynecomastia–true mammary breast tissue in a male–during SMR 3. The firm lump may occur under only one nipple, under both nipples, or under the two at different rates or sizes. The lumps are often tender when they are growing the fastest. In at least 90% of kids, these will go away on their own. They may disappear as quickly as in a few months, but it is not unusual for them to last up to 2 years (Nelson Textbook of Pediatrics, WB Saunders, 1996). In some children, they may persist without being a problem. Gynecomastia occurs in at least 40% to 60% of boys (Fortschritte der Medizin, 1998; 116:23–26).

Gynecomastia can run in families, and when it does, the disappearance pattern tends to be similar in the family. Gynecomastia can happen in boys of any size but it is more common in bigger teens–either taller, heavier, or both. Obesity can certainly be a cause of gynecomastia in some children (Clinical Pediatrcs, 1998; 37:367–371).

Gynecomastia is different, though, than fatty tissue in the breast area. Boys tend to store extra fat in the upper body (breast and abdomen area), but girls are much more likely to store it in the lower body, particularly the thighs (Pediatrics, 1998; 102:e4). This is the first place it goes on and the last place it comes off. If girls’ breasts do enlarge by storing fat, this is usually one of the first places it disappears with weight loss.

Here are times to worry about lumps in a boy’s (not a newborn’s) breast:

  • If they begin before age 10 years or after age 15 years (especially after puberty is complete)
  • If they are not directly under the nipple
  • If there is overlying dimpling of the skin, skin ulceration, or change in the color of the skin
  • If the they feel fixed to the skin
  • If they are large–over 1.5 inches (4 cm) in diameter
  • If they don’t go away within 2 years
  • If the nipples leak milk, blood, pus, or other fluid
  • If there are other signs of disease–night sweats, fever, or weight loss, for example

These are all situations in which a breast lump should definitely be examined, in addition to the important regularly scheduled physicals during the puberty years. These children should have a careful physical examination right away. They should probably have an endocrinology (hormone) workup and perhaps an ultrasound or a mammogram, depending on the exam. I would also consult with a health care provider if a breast lump is associated with any signs of infection, such as sudden increased size, warmth, tenderness, drainage, redness, or fevers.

Fibrocystic breast disease

In a recent study at Johns Hopkins University of 60 high-risk boys with large lumps (> 4 cm), most of the boys–45 of them–turned out to be fine, but 15 did have significant medical problems, including one who had a serious cancer. Most of the problems were genetic (such as Klinefelter’s syndrome–XXY boys) or hormonal problems that needed to be treated (Clinical Pediatrics, 1998; 37:367–371). Gynecomastia can also be a side effect of taking steroids or other medications. It can come from liver disease, testicular disease, or neurologic diseases.

If you are ever unsure whether a breast lump is normal, it is always wise to seek the advice and opinion of your child’s doctor.

Good breast health practices for teens include:

  • Avoiding steroid supplements
  • Avoiding steroid medicines where possible (e.g., keep asthma well controlled with preventive measures)
  • Avoiding cigarette smoking and exposure to second-hand smoke
  • Avoiding alcohol
  • Being physically active daily (exercise)
  • Eating a healthy, whole food diet
  • Maintaining ideal weight
  • Avoiding piercing and tattooing

If normal, benign gynecomastia is bothersome, either because it is large or because it doesn’t go away as puberty progresses, treatment is possible. Sometimes hormones are given to try to shrink the breast tissue. Alternatively, the mammary breast tissue can be removed. A tiny incision is made under the armpit, and the tissue is removed with a fiberoptic scope. The results are great, and the scar is small and inconspicuous (Annals of Plastic Surgery, 1998; 40:62–64).

Normal, small gynecomastia is yet another reminder of the wonderful changes in your son’s body as he becomes a man. While teenagers can be quite trying to live with at times, savor every moment you can as you enter the last few years of having your son in your home.

Did this article help answer your questions on Breast Lumps in teens? Do you still have questions? Let us know in the comments below.

Reviewed by: Khanh-Van Le-Bucklin, Liat Simkhay Snyder
Last reviewed: March 01, 2011
Dr. Alan Greene

Article written by

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

 

Comments

  • derra

    Wow the answer was so informative and helpful. I was just on my way to take my13 year
    old son to the emergency room. Thank you I have. a better understanding .
    ….Marie H.

    • http://www.facebook.com/drgreene Alan Greene

      I’m so glad! Thanks, Marie.

  • Debbie

    My concern with this is that there may be too much estrogen their bodies!! And he’s getting an overload somewhere! I have an 11 yr old who just had a bud, and i’m not sitting around and waiting for it to go away! I have ALWAYS fed my children organic, have a water purifier on the house, they drink 100 % natural spring water that is delivered in a GLASS container; my household cleaners are all natural, soap derived (not oils, such as tea tree, rosemary, sesame, lavender.. these all MIMIC estrogen!!! ), so for me, I don’t know where he is getting the extra estrogen from. I am giving him a supplement of DIM twice a day… it’s for women who are estrogen dominant. It’s naturally derived from broccoli. Hope this helps some people who may ‘blow this off’

    • http://www.facebook.com/drgreene Alan Greene

      I agree, Debbie, that reducing excess estrogen exposure is wise for all of us. The hormones used to fatten conventional cattle are still there when you by beef at the supermarket — Beef is one of my top foods for people in general to choose organic over conventional (http://www.drgreene.com/dr-greenes-organic-rx-item-8/), and at the top of my list for pregnant women and kids (I’m not saying they should eat beef, but I recommend that if they do, they choose grass-fed organic). The pesticide atrazine is another big concern for me. It works by by turning testosterone to estrogen. It’s the number two herbicide in the US, and in the drinking water of 30 million Americans. But if you are drinking purified water and eating organic food, the risk of exposure is far lower – unless you live in the corn belt. I’m glad you mentioned GLASS, because as you know, many plastics contain estrogen-like compounds.

      Vitamin D, Brazil notes, and almonds may help improve the estrogen ratio.

      But having said all this, the lumps in healthy, normal-weight boys going through puberty are thought to be a normal part of their own pubertal hormone surges and not a reason for concern themselves.

  • Kelly

    Hello, I thought I would do a search on this topic and look where I landed! My son turned 17 in April and this is the end of Sept. When he was 13 -14 I think, he did develop the hard lumps under his nipple. I took him to the Dr. and was told this was normal and it eventually went away. However, it is happening again – at over 17 years of age! He was born with an undescended testicle that was surgically corrected when he was just over a year old or so. He has a deep voice and plenty of facial and leg hair. Does this mean he may have a second growth spurt? I hope so since he is 5’7″. Any information is greatly appreciated.

  • mark rhoads

    Dr. Green my son is 8 months old and in the middle of his right nipple looks like a white pimple, Iits really starting to worry me. Its been the for about two and a half months and gwtting bigger. We have been told its nothing to worry about but it seems to be getting worse. Any ideas? Please help!

    • Alan Greene

      Mark, the good news is that most of the time this turns out to be fine in babies – and especially when it’s been seen by a pediatrician who is not concerned. I do suggest, though, having it checked at every doctor’s visit to be sure the progress is matching expectations. All the best!

  • Stephanie

    Hi Dr. Greene,
    my son is 3 1/2 and he has had a tiny cyst like node on his right nipple, on his arreola. It seems like these breast lumps are a somewhat normal thing for girls/boys in the puberty stage, but is it normal for a toddler? I think he’s had it since he was before 2 years old, but and i never thought anything about it until now. He often plays with it and I am just curious about it now. It feels hard and it is underneath the skin. It is beside his nipple. Thank you..

  • Heather Mistler

    My comment is similar to most of the posts. My son turned 11 today and discovered a lump on left breast right before our vacation last week. He said it doesn’t really bother him, but knowing it is there, he is fixated on it. In addition, he has been on Risperdal since he was 4 and I’m seeing a surge of information these days regarding breast growth associated with Risperdal. We have a slew of labs ordered and will be getting them in the morning. I am having a difficult time finding first hand information regarding medication and it’s effects on the endocrine system. How often do you see scenarios such as this? Thanks!

    • http://DrGreene.com/ Cheryl Greene

      Approach

      C-

      • Heather Mistler

        I don’t really understand your reply. My apologies…..

        • http://DrGreene.com/ Cheryl Greene

          Heather,

          My apologies and how confusing.

          My last reply “Approach. C-” was an accident. We use Disqus to host our comments on DrGreene.com and I moderate them. Occasionally someone will post a “Spam” comment or will disrespect another person who has made a comment. We do not “Approve” those comments. All others are read and “Approved” so everyone can see, read, and respond. I was reading your comment on my phone and meant to type “Approve”. Instead I typed “Approach”. The “C-” is a part of my signature line on my phone and is short for “Cheryl” NOT a grade.

          I’m sorry for the confusion!

          C~ (For Cheryl Greene ;)

          • Heather Mistler

            Thank you for the clarification :) We are patiently awaiting labs to find out what’s going on.

          • http://DrGreene.com/ Cheryl Greene

            As Dr. Greene says, it’s most likely normal, but I’ll keep my fingers crossed!

  • Nicholas

    I’m 14 yer old and kind of have the same thing

  • Nicholas

    And a boy

  • Payton

    I am 12 almost 13 I have a lump under my left nipple that has been there about2-3 months that I’ve noticed. It is hard and has increased in size slightly I think should I see a doctor?

  • Austin

    Hi Dr i am 13 and I have noticed a lump behind my right nipple and a smaller one behind my left should I be worried??? They are tender when pressing on them or getting hit. I am getting concerned but i read this article and i think i have Gynecomastia. What’s your thoughts?
    Thanks

  • Diana Cruz

    Hi Dr. Greene, my child (six years old/girl) I notice her breast are big and I just don’t know if that’s normal, cause I examed her and she does have a lump under each nipple, and it just came out of nowhere…should I take her to the Dr…?