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Q: My eight-year-old daughter's left nipple is enlarged and has a hard lump under it. After her doctor examined it, he told us it was a breast bud and not to worry. No other signs of anything unusual turned up in the exam. Is this common? Should I get a second opinion to rule anything else out? I appreciate your attention to my concerns.
A: It sounds like your daughter is simply in the early beginnings of puberty. What you have described does sound very much like a breast bud, which is common particularly in girls at this stage. Oftentimes a small firm mass is appreciated right under the areolar (darker-colored) tissue on the chest. It can be on only one side and is movable, not attached to the muscle or ribs beneath, and does not cause any pain. There is no discharge from the nipple, no dimpling of the skin in the area, and no evidence of infection. Once someone feels it, however, the family tends to follow it more closely, checking it frequently to see if it changes at all. This can cause it to become sore because of the constant manipulation.
I do not think you need a second opinion at this time. A breast bud generally does not suggest that there are any significant hormonal problems or that this is related to breast cancer (if there is a family history of breast cancer, I would mention it to your child s doctor). By having her examined, the doctor gets a good history, checks to see if there are any other signs of puberty, any evidence of secondary sexual characteristics developing, or other possible causes for the lump.
Reassurance is appropriate along with just observation over time. If the area seems to be infected, seems to be getting larger, or discharge is noted from that nipple, then I would have her reevaluated.
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Henry Bernstein, M.D., is currently the associate chief of the Division of General Pediatrics and director of Primary Care at Children's Hospital, Boston. He also has an academic appointment at Harvard Medical School.