Thelarche

Thelarche, also known as breast budding, is the onset of secondary breast development, often representing the beginning of pubertal development. It is the stage at which male and female breasts differentiate due to variance in hormone levels; however, some males have a condition in which they develop breasts, which is called gynecomastia. Thelarche typically occurs between the ages of 8 and 13 years with significant variation between individuals. However, the initial growth of breast tissue occurs during fetal development. It is usually the first sign of puberty in females (less commonly, it can be the second sign, after pubarche). Usually, females experience menarche about two years after thelarche has begun, with complete breast development from thelarche to adult breasts, taking between 2 and 4 years but can last up to age 18. Moreover, puberty is considered delayed if breast development does not start at age 13 or if a female has not had her first period (menarche) within three years of thelarche. Additionally, secondary breast development occurring before the age of 7 years could be a sign of premature thelarche or precocious puberty. Of note, for some girls, thelarche will occur, with subsequent regression of breast development, and then months or years later, normal breast growth will commence again accompanied by normal pubertal changes; this is termed transient thelarche. Pubertal changes, including breast development, are assessed using the Tanner scale (Sexual Maturity Rating Scale) where stage 1 is before, stage 2 is the breast budding or thelarche stage, stages 3 and 4 are continual breast growth and areolar development, and stage 5 signifies completion of development. This system does not use breast size but instead examines the shape of breasts, nipples, and areolae to determine the progression of growth. Various hormones interact and result in the changes seen during thelarche....