Paediatric breast disease and developmental breast cysts - reflection on 20 years of experience.

Introduction: Presentation with breast symptoms in the paediatric population is common but there is little existing literature on the workup and management of breast disease in this population.

Methods: Retrospective series of 140 cases of breast disease in the paediatric population managed by a single surgeon in Adelaide, South Australia between 2004 and 2024. Review of patient demographics, presentation, investigation, management and outcomes of various breast symptoms and pathologies using descriptive analysis.

Results: We reviewed 140 cases including 135 females and 5 males, aged 8-18 years (median = 15). The most common reason for presentation was breast lump (n = 86, 61%), followed by large breasts (n = 13, 9%), asymmetry (n = 11, 8%), abnormal development (n = 8, 6%). Most patients were investigated with ultrasound (n = 101, 71%) and FNA biopsy was performed in cases of non-diagnostic ultrasound or to distinguish fibroadenoma from phyllodes tumour (n = 17, 12%). There was a single case of malignancy and the most common diagnoses were developmental breast cyst (n = 36, 26%) and fibroadenoma (n = 33, 24%). Gynaecomastia was the only diagnosis in males (n = 5, 4%). Majority of patients were managed non-operatively (n = 101, 72%), indications for surgery included fibroadenoma (n = 18, 13%), breast hypertrophy (n = 8, 6%) or abnormal breast development (n = 4, 3%).

Conclusion: We reviewed 140 cases of breast disease in the paediatric population over a 20-year period. Malignancy in this population is rare but requires exclusion with history, examination and ultrasound where appropriate. Developmental breast cysts are the most common pathology, require early identification to avoid unnecessary invasive investigation and should be managed expectantly where possible.