Mild breast tenderness often occurs premenstrually in association with fibrocystic changes or exercise or as a sign of early pregnancy. Severe breast tenderness is not a major complaint of healthy adolescents. Asymmetry of the breasts is common, especially in the early stages of breast development. In all cases of breast asymmetry, a careful examination should be made to rule out a breast mass, cyst or abscess.

The congenital absence of one or both nipples is very rare and may not be associated with absent breast tissue. A lack of breast development may be secondary to congenital absence of glandular tissue, a systemic disorder, radiation therapy, congenital adrenal hyperplasia, gonadal dysgenesis, hypogonadotropic hypogonadism or rarely an intersex disorder or 17a-hydroxylase deficiency.

In cases of a breast mass the work-up should include a complete physical examination and assessment of the mass including evaluation of consistency, size, mobility, tenderness, warmth, overlying skin changes, and associated discharge. The majority of adolescents who complain of a "breast lump" have normal breast tissue or fibrocystic changes. These changes may be due to an imbalance of estrogen/progesterone.

For more information go to the Center for Young Women's Health website.