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CHAPTER 16 ■ BREAST LESIONS JONATHAN ORSBORN, RAKESH D MISTRY INTRODUCTION Most breast lesions in children and adolescents are benign and self-limited, and patients and their families will generally benefit from reassurance that neoplastic diseases of the breast are extremely rare in all pediatric age groups This chapter focuses on the diagnostic approach to the variety of breast lesions, and discusses the management of common etiologies that pediatric emergency physicians are likely to encounter DIFFERENTIAL DIAGNOSIS Breast lesions in children are typically divided into the following categories: infections, benign cysts or masses, malignant masses, abnormal nipple secretions, lesions associated with pregnancy and lactation, and miscellaneous causes, including both anatomic and physiologic entities ( Table 16.1 ) A complete history and physical examination narrow the differential diagnosis and usually provides sufficient information to guide management With few exceptions, most breast lesions require little diagnostic testing in the emergency department (ED) and typically can be managed with supportive care and occasionally, outpatient referral to an appropriate specialist The commonly encountered disorders ( Table 16.2 ) are almost always benign, but consideration must be given to potentially life-threatening processes ( Table 16.3 ) Breast Infections Infection in the breast may take the form of a mastitis, cellulitis, or abscess The incidence of breast infection occurs bimodally, with the early peak in the neonatal age group and the later, more common, peak in postpubertal females Neonatal breast infection (mastitis neonatorum) most frequently presents in the first few weeks of life, commonly resulting from infection of the already enlarged breast bud produced by intrauterine maternal estrogen stimulation As a result, mastitis neonatorum is more likely to occur in full-term, as opposed to premature infants The most common infecting organism is Staphylococcus aureus in >75% of cases, although gram-negative enterics, anaerobes, group A or group B streptococci may be isolated More recent studies have demonstrated an increased incidence of community-associated methicillin-resistant S aureus (CA-MRSA)