The surgical treatment of benign breast lesions in young adolescents.

AIM: There is much controversy surrounding the treatment of benign breast lesions in young adolescents: on one side the need for surgical treatment and on the other doubts in regard to operating on young patients with a benign disease. Another element sparking the debate is the correlation between the appearance of fibroadenomas and the presence of elevated prolactin levels in the blood.

MATERIAL OF STUDY: 42 patients between the ages of 14 and 21 being treated at the General surgery and Geriatrics Unit of the Department of Gerontology, Geriatrics and Metabolic Diseases at the Second University of Naples between 2001 and 2004. In addition, blood prolactin levels were measured in 24 patients.

RESULTS: Only 4.76% of the patients examined (2 cases) had a family history of breast tumours. Out of a total of 42 adolescent patients that were operated on, we detected fibroadenomas in 35 (83.34%), fibrocystic disease in 3 (7.14%), adenosis in 3 patients (7.14%) and a phylloid tumour in 1 (2.38%). Blood prolactin was measured in 24 patients and in 17 cases we detected increased plasmatic levels of this hormone; in addition, anamneses revealed that of these 17 patients, 9 were using oral contraceptives.

DISCUSSION: The most common cause of palpable breast masses in adolescents under 21 years of age are fibroadenomas. The connection to hormonal, genetic and family factors is still unknown, both during the genesis of this pathology and as concerns an increased risk of possible malignant development. The correlation between fibroadenomas and elevated prolactin serum levels still remains controversial today. Various studies, measuring the blood concentration of prolactin in many patients have demonstrated that both elevated blood levels of this hormone and the use of oral contraceptives play a role in the development and growth of benign breast lesions.

CONCLUSION: Fortunately, breast disease is rare in adolescents; these patients do not often develop nodules and where these do occur the vast majority of cases involve benign lesions. A thorough follow-up on patients with nodular breast lesions is thus useful. As concerns the connection between prolactin and fibroadenomas, we also reported interesting data; this represents 70.83% of our subjects.

KEYWORDS: Blood prolactin levels, Fibroadenomas, Surgical treatment.