Volume 21, Issue 4, December 2005

Table of Contents 21-4

Plastic Surgeons’ Perspective on Pediatric Breast Anomalies

• This Article
• Printer Friendly
• Email Paper

Case reports and small series dominate the literature on pediatric breast abnormalities. Thus, Drs. Sadove and van Aalst reviewed the senior author’s twenty years’ experience. There were 66 patients with congenital and acquired pediatric breast anomalies from 1982 - 2002. Retrospective chart reviews enabled the authors to successfully apply a classification system borrowed from the craniofacial literature. Breast abnormalities were therefore categorized into hyperplastic (n = 44), deformational (n = 11), or hypoplastic (n = 11).

Polythelia (supernumerary nipples or nipple-areola complexes) is the most commonly occurring pediatric breast anomaly (reported at 5.6%). It may occur as a sporadic or familial trait, isolated or associated with nephrourologic anomalies. Such lesions should be excised before puberty due to the potential for cancerous degeneration and the need for wider resection after glandular growth during puberty in girls. However, in these cases, the authors reported hyperplastic abnormalities (gynecomastia [n = 20] and juvenile hypertrophy or hyperplasia [n = 14]) as the most frequently encountered conditions.

The categorization schema allowed more systematic observations regarding preferred surgical techniques, timing for surgery, and likelihood of multiple operations. The factors discussed aid in anticipating clinical outcomes.

Sadove AM, van Aalst JA. Congenital and acquired pediatric breast anomalies: A review of 20 years’ experience. Plast Reconstr Surg. 2005;115:1039-1050.

Editor’s Comment: The categorization approach framed the review into a very logical march through the differentials and surgical treatments of pediatric breast abnormalities. Complemented by multiple illustrations, the text provides a succinct and clear review useful to physicians involved in the care of patients with breast abnormalities.

The paper, of course, provides the perspective of the plastic surgeon. Increased development of aromatase inhibitors, primarily aimed at the adjuvant treatment and prevention of breast cancer, has recently encouraged medical, rather than surgical, approaches to hyperplastic breast abnormalities.¹ Case reports have described significant reductions in breast size achieved by treating gynecomastia with aromatase inhibition.² Aromatase inhibition has also been reported as effectively reducing breast tenderness in gynecomastia.³ However, carefully controlled clinical trials are needed, especially for pubertal gynecomastia, which already has a high spontaneous remission rate. In a randomized, double-blind, placebo-controlled trial (n = 80), treatment with anastrozole over a period of 6 months did not significantly exceed placebo in eliciting at least 50% reduction in breast size for pubertal gynecomastia.⁴ More work is needed to determine the appropriate patients (eg hyperplastic breast conditions other than gynecomastia, prepubertal vs pubertal gynecomastia, duration of gynecomastia prior to treatment, treatment objectives, etc.) and medical regimens for aromatase inhibition to be an efficacious treatment alternative to surgery.

Adda Grimberg, MD

References - (linked to )

1. Karaer O, Oruc S, Koyuncu FM. Acta Obstet Gynecol Scand. 2004;83:699-706.
2. Kara C, Kutlu AO, Tosun MS, Apaydin S, Senel F. Horm Res. 2005;63:252-256.
3. Riepe FG, Baus I, Wiest S, Krone N, Sippell WG, Partsch CJ. Horm Res. 2004;62:113-118.
4. Plourde PV, Reiter EO, Jou HC, et al.J Clin Endocrinol Metab. 2004;89:4428-4433.

• This Article
• Printer Friendly
• Email Paper