A multidisciplinary group of physicians at Children's Hospital Boston is
launching the Adolescent Breast Center. It will be the first of its kind in the country and will treat a variety of benign breast problems in adolescent
patients. In recent years, the incidence of breast problems has risen sharply, likely the result of skyrocketing obesity rates. Many patients who present to plastic
surgeons for breast problems also require other forms of treatment—whether
psychological or physical, according to Children's plastic surgeon Brian Labow, MD, assistant in Surgery, who's spearheading the new center. "So we want to
provide comprehensive care."
With his colleagues, plastic surgeon Arin Greene, MD, MMSc, and
pediatrician Amy DiVasta, MD, MMSc, of Adolescent Medicine, Dr. Labow is
actively recruiting practitioners in other specialties to join the center. "We're
looking to our colleagues in Gynecology, Adolescent Medicine, Endocrinology, Psychiatry, Social Work and Nutrition to collaborate in the management of these patients," he says. "We already have all of the necessary clinical expertise here at Children's; it's just a matter of linking like-minded clinicians in a way that will be better for patients."
While the Breast Center will formally open in the fall, Dr. Labow and colleagues are already treating patients with breast problems. The most frequent diagnosis that
Dr. Labow makes in female adolescents is macromastia, oversize of the breasts or mammae that can cause chronic neck and back pain.
"The breast tissue can weigh up to several pounds, to the point that it will literally be lifestyle-altering and physically detrimental to day-to-day activities," Dr. Labow says.
A reduction mammaplasty is performed on adolescent patients to improve the shape of the breasts and diminish their size. Even if a patient continues to grow after surgery, breasts rarely return to pre-operative proportions.
Surgery is not the only means to treat these patients, however. In some cases of major breast asymmetry, surgery may not be
appropriate based on age, weight or patient preference, and the center can connect these patients with specialized vendors that make prosthetics for bras and bathing suits. In cases of minor breast asymmetry, for example, surgery may be unnecessary. Dr. Labow discourages breast reduction or augmentation for patients
exhibiting slight, natural differences in breast size. "It's not a
small operation," he says. "Scars will be visible and there can be
complications, including altered nipple sensitivity and potential breast feeding and wound healing problems." In light of this, the Breast Center will offer non-surgical options.
The Breast Center will also treat males, many of whom
suffer from gynecomastia, an excess development of breast
tissue in a male's breast or breasts. Surgery, which usually
involves a combination of liposuction and surgical excision of breast tissue, has a high success rate. A mastopexy is sometimes required as part of the procedure to remove excess skin and raise sagging breasts.
Gynecomastia can be caused by a range of factors, including an array of medications, illicit drugs and medical conditions (see Web address at end of article). Sometimes, gynecomastia is a symptom of an underlying issue, such as a pituitary gland
tumor or a genetic disorder like Klinefelter's syndrome. Since Children's treats so many patients with rare etiologies, Breast Center clinicians have the advantage of being familiar with
these conditions.
Gynecomastia is not uncommon in adolescent boys, when
hormonal changes in the early stages of puberty can cause a temporary enlargement of the breast glands. In 90 percent of the cases, the enlargement diminishes within three years. When
deciding whether to operate, Dr. Labow looks at a patient's
overall sexual maturation; for a 13-year-old boy who just
began pubertal changes, for example, he recommends waiting, not surgery.
Many cases of gynecomastia are due to obesity, and treatment of these patients focuses on developing a nutrition and exercise plan, so the Breast Center plans to enlist a full-time nutritionist. For some obese patients, weight loss can make surgery less
extensive or even unnecessary. "Rather than performing surgery on a 13- or 14-year-old patient, we want to help these kids
manage their weight, avoid type II diabetes 40 years down the line and get healthy," says Dr. Labow. He notes that gynecomastia often motivates teens to change their eating and exercise habits.
The Breast Center was founded out of a growing awareness that breast-related problems are often multidimensional. "It's very
different having a breast problem in adolescence than in your 40s, 50s or 60s," Dr. Labow says. "It can make a very difficult time in someone's life even more difficult." Gynecomastia, while
physically benign, can have a devastating psychological impact. Driven by embarrassment or depression, males with
gynecomastia often become socially withdrawn. As a supplement (or alternative) to surgery, the Breast Center can provide many forms of support, through Adolescent Medicine, Social Work
or Psychiatry.
Care of adolescent breast problems is very much a developing field. "Right now there is not a lot of data, and not much has been formally written about the best ways to treat adolescent breast problems," Dr. Labow says. The center will establish a database to follow patients and record which strategies, whether surgical or non-surgical, are most successful. "We can look back in five or six years, potentially with publishable conclusions, to evaluate the best practices," he says. "And hopefully we can develop
superior care for our patients."
