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.

First We Test Whether Breast Enlargement Is Possible Or Not 

After above investigation we make the decision about whether breast enlargement possible or not. We prescribe the hormone treatment only if the above investigations suggest for the scope of further breast enlargement.

Diagnostic Therapeutic Response Test

This procedure is required in some patient, if above test still does not clarifies of the possibility of breast enlargement. For this hormone & other treatment is given for three month in the form of female hormone tablet, local hormone application at breast skin, or vaginal gels & additional other therapy. If breast enlarges in size i.e. it grows in size by more than 2 cm in these three months, it means breast of that patient has potential for further growth. Once it is decided by above test that breast has potential for further growth, in such patient further courses of hormone therapy is given. By few courses of hormone treatment breast enlarges to normal size in approximately one year time. By this therapy breast size as well its consistency in firmness also increases. Thus breast becomes large in size, more attractive & develops firm protruding look. This breast enlargement treatment is very effective in those patient’s in whom investigations & physical examination shows significant abnormality. Thus most patients achieve fully normal breast. As breast size increases in size patient's confidence increases and feeling of well-being is achieved.

How this treatment works

When we give below-mentioned hormones by any of the below-mentioned routes. The concentration of these hormones in blood circulation rises. This leads to binding of more hormones on estrogen receptors of breast. After binding with receptors these hormones leads to certain changes in the breast tissue. This leads to multiplication of breast tissue leading to further growth. This continued multiplication of breast tissue leads to further breast growth. This continued multiplication of breast tissue under the effect of above mentioned hormone treatment continues till breast size normalizes. Usually in one-year time breast size as well as texture i.e. firmness normalizes. Unluckily most doctors have less knowledge about hormone treatment for this problem & also they think the problem of small breast as more of cosmetic problem so that they neither investigate the patient nor give hormone or other medical therapy for breast growth.

Various therapeutic options of breast enlargement are available as:

This treatment can be either:
a. Hormone & Other Medicine Therapy: available as pills, hormonal skin patches or vaginal creams & other adjuvant drugs are prescribed
OR
b. Surgical therapy: Breast enlargement surgeries, Hormone & Medicine Treatment of Small Breast. We start medical treatment only when above tests shows that breast has capacity to enlarge. It is given in the form replacement of female hormones & other hormone as growth hormone & growth factor replacement. These hormones can be given in the form of oral tablets, skin patches, ointments, gel or creams. 
As this treatment has no side effects, is economical and easy to take either as oral tablets, skin patches, or as gel, thus it is most preferred form of breast enlargement therapy.

The various Treatment options are: 
Treatment of specific disease: Once the cause for absent or small breast is found by above tests then treatment started. Abnormalities of the pituitary and abnormalities in the adrenal glands can be treated by appropriate medicines. Normally patient starts getting improvement in breast size in three to six months.
The various drugs which are required are as follows: 

1) Female hormones replacement: The replacement of female hormones is one of the common treatments for breast enlargement. The various female hormones are as follows: 
a) Estradiol
b) Conjugated equine estrogen
c) Estriol
d) Natural estrogens
e) Prohormones
f) Estrogen skin patches
g) Estrogen vaginal creams
h) Medroxyprogesterone
i) Oral E & P Combination Pill
j) Desgestro
k) Megestrol
L) Norethisterone
N) Hydroxyprogesterone

2) Growths Hormones Therapy: Growth hormone is given when somatotropin deficiency is found & that was cause of small breast..
3) IGF-1 therapy: is given when somatomedin-c deficiency is the cause. 
4) Gonadotropin therapy is also very effective in breast enlargement in many patient.
5) Gonadotropin releasing hormone therapy is effective in many cases of under developed breast.
6) Medicine to increase the fat in breast tissue & body.

But unluckily many doctors do not take the problem seriously leading to patient not given proper treatment. Thus many patients remain having small size of breast & associated lifelong inferiority complex. 

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.

Female Hormone Deficiency

Female Hormone Deficiency (Hypogonadism) is called when female hormone estradiol is less in body. The symptoms of female hormone deficiency are: menstrual irregularity, small breast, decreased desire for sex, dryness of vagina or pain during intercourse.

Cause of female hormone deficiency are hypothalamic disease, pituitary failure, L.H., F.S.H deficiency, prolactin excess, functional, hypothalamic amenorrhoea, defective egg formation or no egg formation at all or ovarian failure due to many of the causes. (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.
 
Investigation: 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: After finding out the cause various hormone defects are corrected. Some short cause of female hormone is given. After treatment of approximately six months body starts forming hormone itself in many cases. Breast development starts uterus starts growing. In next three one year complete development of female sex character develops & menstrual period starts. 

1) Female hormones replacement: The replacement of female hormones is one of the common treatments for breast enlargement. The various female hormones are as follows: 
a) Estradiol
b) Conjugated equine estrogen
c) Estriol
d) Natural estrogens
e) Prohormones
f) Estrogen skin patches
g) Estrogen vaginal creams
h) Medroxyprogesterone
a) Desgestrol
b) Megestrol
c) Norethisterone
d) Hydroxyprogesterone
e) Oral E & P Combination Pill

2) Gonadotropin therapy is also very effective in breast enlargement in many patient.

3) Gonadotropin releasing hormone therapy is effective in many cases of under developed breast.

Response of Treatment: After treatment of approximately six months body starts forming hormone itself in many cases. Breast development starts uterus starts growing. In next three one year complete development of female sex character develops & menstrual period starts.

Breast development at early age (Precocious Puberty) 

Precocious Puberty :Breast development alone or additional sexual development may occur at early age early age (termed as Precocious Puberty). 
Causes: 
If puberty occurs early then there is risk that her height may remain short & some psychological problem may occur. Sometimes their may be risk of sexual exploitation by others as child is still innocent even with good sexual development.

After hormone testing the particular hormone defect is corrected leading to disappearance of breast & pubic hair. Later breast development & menstrual period comes at right time. So In all such cases one should try to find out exact cause of hormone disorder & then treatment should be started there are many suppressant hormone i.e. GnRH analogues which when given to girls then breast & of pubic hair regresses back.

Causes of Precocious Puberty

This can be due to increase in female hormone at very young age due to: 
Ovarian cause, or due to pituitary-hypothalmic disorder as hypothalmic harmartoma, ovarian tumors, congenital adrenal hyperplasia & adrenal tumour & other CNS disorder. It can be due to idiopathic central precocious puberty (i.e. true) or pseudo precocious puberty. Other causes are premature thelarche, & premature pubarche.

Central (GnRH) driven : Idiopathic (sporadic or familial), Central nervous system abnormalities,Acquired (Abscess, chemotherapy, granulomas, hypothalamic hamartomas, sept-optic dysplasia, suprasellar cyst.Tumor (LH-secreting adenoma, astrocytoma, slioma (may be associated with neurofibromatosis), crainpharyngiomas, ependymomas. 
Secondary to chronic exposure to sex steroid (causes of peripheral puberty, CVAH, GIP, tumors) Reversible forms : space-occupying or pressure-associated lesions (Abscess, hydrocephalus) Peripheral (GnRH independent) : Genetic disorders (mutations) , Congenial virlizing adrenal hyperplasia (CVAH), males, Gonadotropin-independent puberty (GIP), males, McCune-Albright syndrome. 
Tumors : Adrenal sex steroid secreting (adenoma, carcinoma), gonadotropin-producing (choriocarcinoma, chorioepithelioma, dysgerminoma, hepatoblastoma, hepatoma, teratoma) Ovarian (granulose cell, may be associated with Peutz-Jeghers syndrome); granulose, theca cell Testicular (Leydig Cell) 

Limited or reversible forms : Chronic, primary hypothyroidism, CVAH, Exogenous sex steroid or gonadotropins, Ovarian cysts.

Variants of normal development : Premature pubarche (Secondary to premature adrenarche), Premature thelarche.

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, MRI.

Treatment Options for Early Puberty 

Treatment of specific disease: Once the cause for early sexual development is found by above tests then treatment started. Abnormalities of the pituitary and abnormalities in the adrenal glands can be treated by appropriate medicines. Normally patient starts getting decrease in breast size in three to six months.
The various drugs which are required are as follows: 

1) Female hormones suppressant: GnRH analogues as triptorelin’ ,naferelin, Gonadorelin, testolactone, MEdroxy progesterone
Some times surgery may also be required

Response of treatment: Normally in three month breast size starts decreasing including pubic hair regresses. This treatment may be continued till the child puberty needs to be deferred. The moment we stop the treatment normal pubertal & sexual development resumes.