epithelial cell proliferation If the discharge persists after delivery, a more thorough investigation for alternate etiologies is recommended Fibroadenomas often increase in size during pregnancy and may result in significant pain Excision is often advised for any solitary mass and the patient should be expediently referred to a breast surgeon The number of cases of breast malignancy diagnosed during pregnancy is very low Miscellaneous Breast Lesions Congenital Lesions Supernumerary breasts (polymastia) and supernumerary nipples (polythelia) are congenital conditions that are unlikely to present as chief complaints in the ED, but that may be discovered incidentally on examination Polymastia results from failure of the embryonic mammary ridges to regress and is present at birth, often resembling skin tags or nevi, and may not be noticed until the tissue is hormonally influenced Supernumerary breasts are most commonly found in the axillae but have been reported to occur in several locations This ectopic tissue may become tender with menses and has been reported to develop the same range of pathology as normal breast tissue, necessitating excision under certain circumstances Polythelia may be sporadic or familial, and is most commonly found on the left, inferior to the normal nipple In newborns, polythelia may appear as small, wrinkled lesions with or without pigmentation Polythelia is typically of little significance, though there is a possible association with unsuspected urologic anomalies For this reason, patients with polythelia should be referred for at least a primary screening of underlying urologic disease Otherwise, this disorder requires no treatment unless the diagnosis is uncertain (e.g., the lesion looks like a possible melanoma) or is perceived as a cosmetic problem Premature Thelarche Premature thelarche refers to isolated breast development without other signs of puberty Minimum acceptable age for thelarche is years; appearance of breast tissue prior to this age should prompt consultation with an endocrinologist Typically appearing within the first years of life in its most common form, premature thelarche is a benign, transient condition of unknown etiology Cases of premature thelarche usually present to the ED secondary to concern raised by parents of prepubertal girls, and reassurance is usually all that is required However, premature thelarche may be the first sign of true precocious puberty or