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Virginal Breast Hypertrophy, Page 2. Go to Page 1
aka juvenile breast hypertrophy (excessive breast development)

Aberrations of Normal Development and Involution

Benign breast disorders account for most breast problems. These conditions are frequently considered in the context of excluding breast cancer and often are not recognized for their own associated morbidity. To provide appropriate management, it is important to consider benign breast disorders from four aspects:
 (i) clinical picture,
(ii) medical significance,
(iii) treatment intervention,
(iv) and pathologic etiology

A framework to understand benign breast problems is called Aberrations of Normal Development and Involution (ANDI).  It includes symptoms, histology, endocrine state, and pathogenesis in a progression from a normal to a disease state. Most benign breast conditions arise from normal changes in breast development, hormone cycling, and reproductive evolution. Three life cycles reflect different reproductive phases in a woman's life and are associated with unique breast manifestations.
  • During the early reproductive period (15–25 years), lobule and stromal formation occurs. The ANDI conditions associated with this period are fibroadenoma (mass) and juvenile hypertrophy (excessive breast development). In this first stage, the progression from ANDI to a disease state results in the formation of giant fibroadenomas and multiple fibroadenomas.
  • During the mature reproductive period (25.40 years), cyclic hormonal changes affect glandular tissue and stroma. In this second period, the ANDI is an exaggeration of these cyclic effects, such as cyclic mastalgia and generalized nodularity.
  • The third phase is involution of lobules and ducts or turnover of epithelia, which occurs during ages 35 to 55 years. The ANDI associated with lobular involution are macrocysts (lumps) and sclerosing lesions (mammographic abnormalities). Those associated with ductal involution are duct dilation (nipple discharge) and periductal fibrosis (nipple retraction), and those with epithelial turnover are mild hyperplasia (pathologic description).
(Baiba J. Grube, Armando E. Giuliano: Benign Breast Conditions in Berek & Novak's Gynecology, 14th Edition, PP. 651 - 652)

ABC of Breast Diseases: Congenital Problems and Aberrations of Normal Breast Development and Involution
The breast is identical in boys and girls until puberty. Growth begins at about the age of 10 and may initially be asymmetrical: a unilateral breast lump in a 9-10 year old girl is invariably developing breast, and biopsy specimens should not be taken from girls of this age as they can damage the breast bud. The functional unit of the breast is the terminal duct lobular unit or lobule, which drains via a branching duct system to the nipple. The duct system does not run in a truly radial manner, and the breast is not separated into easily defined segments. The lobules and ducts - the glandular tissue - are supported by fibrous tissue - the stroma. (BMJ 1994;309:797, published 24 September 1994)