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Thelarche // is the onset of secondary (postnatal) breast development, usually occurring at the beginning of puberty in girls. Its etymology is from Greek θηλή [tʰelḗ], “nipple” and ἀρχή [arkʰḗ], “beginning, onset”. Thelarche is usually noticed as a firm, tender lump directly under the centre of the nipple (papilla and areola). Thelarche is also referred to as a "breast bud", or more formally as Tanner stage 2 breast development (Tanner stage 1 being the entirely undeveloped prepubertal state). Thelarche may occur on one side first, or both sides simultaneously.
Thelarche is the first physical change of puberty in about 60% of girls, usually after 8 years of age. It is a result of rising levels of estradiol. It is typical for a woman's breasts to be unequal in size, particularly while the breasts are developing. Statistically it is slightly more common for the left breast to be the larger. In rare cases, the breasts may be significantly different in size, or one breast may fail to develop entirely.
Although breast development can occur as a part of normal male puberty, it is termed gynecomastia, and the term "thelarche" is not used with reference to male breast development.
When thelarche occurs at an unusually early age, it may be the first manifestation of precocious puberty. If no other changes of puberty or sex hormone effects occur, it is referred to as isolated premature thelarche, and needs no treatment.
As with menarche, many young girls are not prepared for breast development, or have been trained to feel ashamed of breasts through active instruction or modelling. Some possible consequences of such neglect are negative body image, appearance anxiety, lowered self-esteem, and delayed diagnosis of breast tumors. The introduction of research-based educational materials on breast development for primary and middle schools has been proposed to promote breast health by reducing shame.
Premature thelarche is a benign, self-limiting condition which is characterised by breast development with no other signs of sexual maturation. There may well be two types of premature thelarche. The classical type commences during the first year of life and tends to resolve by the age of 2. The second form of premature thelarche, of which the age of onset is over 2 years of age, tends to be more persistent and with a higher incidence of uterine bleeding for the child.
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