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The Informed Parent

Bothersome Big Breasts

by Louis P. Theriot, M.D., F.A.A.P.
Published on Jun. 28, 2004
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Kyle is a six-day-old newborn male who was brought to the office for an “emergency evaluation”. The nurse stopped me in-between patients saying that Kyle’s parents were terribly distraught and worried. Although they did not have an appointment I told the nurse to put Kyle in a room and take his vitals right away.

When I walked into the room I noticed that Kyle was lying comfortably in mom’s arms, vigorously breast-feeding. He did not have a fever and at a glance he seemed quite stable. They proceeded to tell me that when he was being bathed this morning they noticed that his breasts were large and firm. Upon palpating the tissue to evaluate just how large the breasts were, milk was expressed from one side.

“It freaked me out!” his father said, shaking his head. Kyle’s mom added in an apologetic voice, “I feel so bad. I should have done something sooner but I thought that it was normal to have a newborn with enlarged breasts. I’ll just die if I waited too long.”

To allay their fears I commented how handsome and healthy Kyle was looking. I did a thorough examination and, sure enough, both breasts were enlarged and firm. Upon palpating the right breast, milk WAS expressed. With this, Kyle’s dad looked down and shook his head.

I reassured them that Kyle could not be any healthier. His exam was perfectly normal as was the breast enlargement. His body was responding normally to hormones, or estrogens, that he received from his mother through the placenta. This breast enlargement, which is called gynecomastia, occurs in many normal newborns both male and female. It is a transient condition that may last for weeks but will resolve completely without any intervention. For a small number of these babies, if the estrogen level is high enough, milk can actually be expressed. It is often referred to as witch’s milk. This was the case with Kyle; a normal occurrence and of no concern.

They were quite relieved, especially when I showed them a textbook that confirmed all we had talked about. I did mention that since mom was successfully breast-feeding the milk secretion may persist a bit longer. “Not a problem,” she said with a smile. “I can certainly live with that.”


Annie is a cute two-year-old who came to the office for a sick visit. In getting the history mom told me that over the past few months she noticed Annie’s left breast was “developing”.

“I probably could have waited until her two-year well-check which is next month. But I started to get worried after talking with some family members. My cousin is a nurse, and she mentioned something about cancer or tumors. So I just couldn’t wait.”

I sensed mom’s anxiety. “Why don’t we just do her two-year visit today?” I had the nurse check her height and weight, and plotted them on the growth curve. She was right at the 75th percentile for both. Her blood pressure was normal. I did a complete exam and did note the enlarged left breast. I commented to mom that there were no lumps. The nipple was normal and there was no discharge. There was no evidence of pubic or axillary hair. The vaginal area was completely normal and there were no enlarged lymph nodes.

Annie has premature thelarche, which is very common in females between the first and third years of life. The hallmark of this condition is breast development that occurs without additional signs of sexual maturation in children under the age of eight years. It may involve one or both breasts. The degree of enlargement may fluctuate but it should not progressively worsen. It may take a couple of years to finally regress. Children with premature thelarche are normal. Their growth is standard; their periods start at a regular time without any abnormalities and their ability to have children is not hindered in any way.

After all of this Annie’s mom said, “Thank you so much for going through this with me. I guess I really was worried but didn’t want to admit it. What a relief!”


John is a muscular 14-year-old who came to the office with his mother. When the nurse put him in the room he refused to tell her why he was here. When I walked in he flashed a glaring look at mom. She stood up and said, “I’ll let you do what you have to do. I’ll just wait outside.”

Not knowing exactly what I was getting into I asked John if the nurse had taken his blood pressure. I knew full well that she had not. “No,” he replied.

“John, why don’t you go with the nurse and let her get your BP.” This gave mom and me some time to talk. She reported that John had one breast that was noticeably large. He was terrible self-conscious and refused to be seen without a shirt. He had passed up swimming parties and trips to the beach with his friends because of it.

Upon returning to the room he handed me the report of his BP. I asked mom to step outside while John and I talked and I did my exam. As soon as she had left he confided in me how embarrassed and worried he was about his breast. His left breast was noticeably enlarged, but there was no discharge nor were there lymph nodes in the armpit area. Interestingly, the right breast had a pea-size lump under the nipple. This was freely moveable and quite tender. John hadn’t even noticed this himself.

The rest of the exam was normal and I assured him that the condition he had was common. I had mom come back into the room. It was important to confirm that John was not taking any medications since some meds can cause breast enlargement. Through the history and exam I was able to rule out any liver disease. This can also cause enlargement of the breasts. I went on to tell them that John has pubertal gynecomastia which is a normal physiologic condition. It occurs in up to 66% of all teenage males usually between l3 and 14 years of age, at mid-puberty. It may be as subtle as a tiny lump the size of a BB. Or it may be quite noticeable like a female who is going through puberty. It is due to a temporary imbalance of the female hormone estrogen and the male hormone androgen. It usually regresses within a matter of months, and rarely persists beyond one year.

To further put John‘s mind at ease, I pulled out some articles about this and made copies. He was genuinely relieved but added, “Well, looks like it will be a long while before I go to the beach, but that’s cool!”




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