For Physicians | Overview
The Adolescent Breast Center offers unique, specialized care for breast conditions. We bring together medical and surgical providers from across Boston Children's Hospital, specifically physicians within the departments of Adolescent/Young Adult Medicine, Plastic and Oral Surgery, and General Surgery. Depending on the diagnosis, we may opt to refer patients to one or more of these departments for further evaluation or treatment.
We do everything we can to make the referral process seamless, and we work closely with referring physicians to coordinate follow-up care.
Referrals and second opinions
Our specialists are happy to answer any questions you may have about referring a patient or getting a second opinion. Members of your office staff (or the patient) may contact us, and a member of our staff will help arrange an appointment. It's very quick to get an appointment with the Adolescent Breast Center in part because we don't require many tests (such as MRIs) beforehand. Our physicians are also happy to speak with you directly regarding any questions you may have.
As a primary care physician or other specialist, you may refer your patient regardless of your affiliation with Boston Children's. However, there may be limitations with your patient's insurance provider that may prevent the patient from being seen by a provider in our clinic. Our staff is here to help you sort out those details and provide any additional information you may need.
Frequently asked questions
When young patients express concern about their breast health or development, physicians sometimes wonder when and where to refer them. In 2007, experts from a variety of specialties across Boston Children's Hospital recognized the unmet need for comprehensive adolescent breast care and established a center uniquely dedicated to breast conditions. We now partner with pediatricians and primary care physicians from around the country to provide specialized care to their patients. Below, we cover some of the most common questions we hear from referring physicians. We hope the answers will help you determine whether an evaluation at the Adolescent Breast Center is right for your patient.
Why choose Boston Children's?
We heard stories of teens and their parents being sent from one doctor to another and still not getting the answers they needed. We created this first-of-its kind center as a way for patients to more rapidly access information and care.
Although many adult specialists treat these diagnoses, they may be unfamiliar with issues specific to adolescent patients. We set out to establish best clinical practices for our patients and to support that effort with a unique and growing research program. The center has now become a model nationwide.
The most common diagnoses include breast masses, macromastia, and gynecomastia. However, we also see rarer diagnoses such as Poland syndrome, tuberous breasts, and secondary deformity from trauma, disease, or surgery.
Our clinical research in adolescent breast disorders has documented the psychosocial, emotional, and physical reduction in health-related quality of life associated with some of these conditions. We've also been able to study the effectiveness of surgical treatment in several common diagnoses. We've measured quality of life, self-esteem, breast-related problems, and eating patterns in more than 500 teenagers with chest and breast conditions.
We've published work quantifying how macromastia, gynecomastia, and breast asymmetry negatively impact the quality of life of adolescents. Our work has been seminal in this field and has been discussed in the lay media and the subject of news reports.
Furthermore, we've established positive outcomes following treatment for patients with gynecomastia and macromastia. This work supports our treatment recommendations for our patients and has been presented nationally to both surgeons and non-surgeons alike.
The center takes an all-encompassing approach to breast health. The departments of Plastic and Oral Surgery, Adolescent Medicine, Endocrinology, and General Surgery at Boston Children's are all involved in patient care. In addition, our doctors are adept at partnering with community therapists and weight-management programs that patients may already be working with. We recently started a collaboration with the Gender Multispecialty Service (GeMS) here at Boston Children's and are excited to open our doors to a wider population of young adolescents.
We also have a close working relationship with Friends' Place at the Dana-Farber Cancer Institute focused on creating non-surgical solutions, including customized silicone breast prosthesis and prosthetic bras, for patients who are not yet candidates for surgery.
How to know if your patient needs help
Breast conditions in young adults are more common than one would think, but firm numbers are hard to come by. Concerns about their breasts are sometimes difficult for adolescents to talk about, and problems are underreported as a result. In addition, these conditions are almost invariably benign, so they have not been studied to the degree that conditions associated with higher mortality have.
Some evidence suggests that the number of diagnoses may be increasing. One reason could be that girls are getting their periods younger, which could be leading to a longer, more rapid period of breast growth.
Adolescence happens for each individual on a different timetable, so it can be hard to tell when breast development is truly abnormal. Because of this, we do not use a clear age cutoff when evaluating patients, and instead look at the degree of disruption the condition is causing in a patient’s life. For patients with conditions such as asymmetrical breasts, macromastia, or gynecomastia, some signs of this impact include effects on mental health and self-esteem, or a preoccupation with food and body image. Primary care physicians can also watch for indications that the condition is interfering with everyday activities, school, exercise, and sports.
We do not exclusively use age as criteria to exclude or limit access to patients with symptomatic breast conditions. We've treated patients as young as 11 or 12. We're happy to evaluate and establish relationships with patients of any age.
Some forms of treatment are reserved until patients reach "skeletal maturity." Occasionally we will order an X-ray to evaluate a patient’s growth plate and further determine their stage of bone maturity.
Primary breast cancer is extremely rare in adolescents, and we're happy to examine the patient and reassure her of that. Some bumps and pain can be associated with girls' menstrual cycles. Others are benign masses that can be watched carefully and often disappear on their own, or or are removed if they are causing pain or impacting the breast's development.