What is small breast: When the size of breast in girls is less than 36” which is considered ideal, is termed as small breast.( also known as micro-mastia).
How Normal Breast develops: All girls have same size of breast tissue in childhood. At the time of puberty i.e. beginning of sexual development female hormone estradiol, adrenal hormone androstenidione, 17-oh Progesterone, DHEAS, Growth hormone, LH, FSH, increases & SHBG decreases, Thyroid Hormone also plays the role. These hormones changes lead to increased concentration of Free Testosterone, DHT & some more hormones. These hormones then act on the various sensors (called receptors) in the breast tissue. After the interaction of hormones & receptors certain changes occurs in the functioning of cells of breast tissue so that breast cells starts growing in thickness & size & more & more fat starts depositing in the breast . thus breast size gradually starts increasing. Simultaneously it also increases the blood supply to breast tissue leading to more availability of growth factors to the breast tissue resulting in faster growth of breast tissue. These hormones & growth factors are in high concentration during peak of secondary sexual characters development i. e. puberty leading to persistent stimulation of breast tissue for next two to three years i. e. up to completion of sexual development. Thus in normal girls in two to three years full breast develop.
Causes of Small Breast: In girls the small breast can be due to following causes:
1) Female sex hormones deficiency i.e. estradiol in body due to many of the below mentioned causes as leading to absence of estrogen production (hypogonadotropic
hypogonadism). Craniopharyngioma, Germinoma, Hamartoma, Hand Schuller Christan disease, Teratoma, Endodermal, sinus tumors, metastatic carcinoma, Infection and other disorders : Tuberculosis, Syphilis, Encephalitis/meningitis, sarcoidosis, kallmann syndrome, idiopathic hypogonadotropic hypogonadism, Chronic debilitating disease,
Pituitary other hormone-screening pituitary tumors (ACTH, thyrotropin-stimulating hormone, growth hormone), non-functional tumors (craniophyaryngioma), Metastatic carinoma, Space-occupying lesions : Empty sella syndrome, Arterial aneuysm, Necrosis : Sheehan syndrome, Panhypopituitarism, Inflammatory /infiltrative : Sarcoidosis, Hemachoromatosis. Gonadal agenesis, Gonadal dysgenesis, Turner syndrome 45, X, Mosaicism, Pure gonadal dysgenesis, 46, XX, 46,XX (Swyer syndrome), Ovarian enzymatic deficiency as 17a-Hydroxylase deficiency, 17, 20-Lyase deficiency, Premature Ovarian failure : Idiopathic – premature menopause, injury, mumps oophoritis, radiation, chemotherapy, Resistant ovary (Savage syndrome), Autoimmune disease, Galactosemia.
2) Second cause for small breast is resistance of breast tissue to normal level of female hormone in the body. So that even though female hormone is normal in the body, but the breast tissue of these girls do not have sufficient receptors for female hormone leading to insufficient estrogen action meaning that female hormone is unable to work & breast do not grow well. But when female hormone level is further increased by female hormone replacement treatment & certain more medicines are given so that female hormones becomes more effective on breast, then breast tissue starts growing. Breast size then fully normalizes in six months to one-year time.
3) Growth factor deficiency
4) Zinc Deficiency
5) Estrogen biosynthetic defects
6) Congenital adrenal hyperplasia
7) Congenital absence of breast bud
8) Lipoatrophy generalized
9) Ninth Cause is resistance of hair roots to normal level of male hormones, in this disorder male hormone is normal in blood even then hair root do not grow because in hair root there is less male hormone receptor (i.e. sensor of male hormone) so that male hormone is unable to work & hair do not grow well. But when male hormone level is further increased by male hormone replacement treatment & certain more medicines are given so that male hormones becomes more effective on hair roots, then hair roots starts growing. Beard & moustaches then fully normalizes in six months to one-year time.
10) Absence of estrogen receptors in breast tissue
12) Growth hormone deficiency due to hypopituiarism, pituitary disorders
13) Progeria
12) DRUGS: Cytotoxic Agents, Cyclophoamide, Vincristine,Ionising radiation, Azathioprine
13) Overmastectomy
14) Structural Defects Of body fat cell so that they do not grow
15) Generalized hypoplastic syndrome
Investigations & Diagnosis:
For diagnosis of cause of absent or small breast we do following tests.
Complete hormone profile: LH, FSH, total testosterone, Prolactin, Androstenidione, SHBG, 17 HYDROXYPROGESTERONE, DHEAS, Estradiol, Progesterone
Suppression & Stimulation Tests,
Karyotype
Genetic testing
Choromosome analysis
Pro. Challenge test
High Resolution Ultrasound
Mammography
E2 CHALLENGE TEST
Diagnostic Therapeutic Response Test
16) Dysmorphic Syndrome
Investigations & Diagnosis:
For diagnosis of cause of absent or small breast we do following tests.
Complete hormone profile: LH, FSH, total testosterone, Prolactin, Androstenidione, SHBG, 17 HYDROXYPROGESTERONE, DHEAS, Estradiol, Progesterone
Suppression & Stimulation Tests,
Karyotype
Genetic testing
Choromosome analysis
Pro. Challenge test
High Resolution Ultrasound
Mammography
E2 CHALLENGE TEST
Diagnostic Therapeutic Response Test
Treatment Options for Breast Enlargement
Before starting treatment for enlargement of breast all above causes are investigated and proper diagnosis is made. Then we test whether breast enlargement is possible or not.
Response of Medical Treatment:
In properly selected patient, when any of above treatment is started the response is very good & has no side effects. In many scientific studies when the above treatment started breast size increases from previous size of hardly visible breast to as big as 36 inches & in some even larger size of 38 or 40 inches. Thus the trial of treatment should be given to all patients with small breast before asking them to go for surgery. It has no side effects if given in proper disease and in-patients when it is really indicated.
Breast Enlargement Surgery
Surgical Treatment is required when medicine are not effective then there are various surgical procedures which can lead long lasting good size firm breast. Our Cosmetic surgeon performs all breast increasing surgery.
