Breast disorders

Breast development is the badge of femininity which indicates to others that a girl is physically maturing and is in the process of becoming a woman. It is a change of great significance to an adolescent and consequently when breast development is abnormal this is a source of embarassment and distress. Breasts may be absent, too small, too large, deformed or unequal and each of these variations can cause psychological disturbances and call for sympathetic and considerate management.

Breast development will be absent if there is no effective oestrogen production by the ovary. Thus in primary hypothalamic/pituitary failure of gonadotrophin production or in gonadal dysgenesis both of which have been considered in Chapter 8, breasts tend to remain in the prepubertal stage (Stage 1) of development. Sometimes, if some ovarian differentiation has occurred and there has been a brief period of oestrogen activity, slight or moderate development may occur, but in the great majority of patients with these disorders there is none.

Such patients should be treated with replacement hormone therapy using the regime outlined on pages 149–50 or one like it and, as a rule, acceptable breast development will occur (Fig. 10.4). It is better for doses to be kept low in the early stages to allow a gradual response similar to the gradual development of normal puberty: this will mean that the development to Stage 3 and 4 may be a little slow and some patients may become a little disheartened and will need to be encouraged that all is going well. If the ultimate response is indifferent, oestrogen dosage may be increased to 30, 40 or even 50μg of ethinyloestradiol daily, but weight gain is sometimes a problem with increasing dosage and the response is not always greatly improved.

Other regimes have been employed as an alternative to that recommended on pages 149–50 or if the response to that dosage schedule has not been satisfactory. [...]