1. Anibal Espinoza Cristian Garcia
US Puberal Breast
Anibal Espinoza
Cristian Garcia

2. US Puberal Breast
The human female breast undergoes two separate phases of growth and differentiation. The first occurs during fetal development and results in the formation of simple branched ducts. The second period of growth occurs at puberty, when the ducts elongate, divide, and form terminal duct lobular units.
The prepubertal breast consists of simple branched ducts. The rapid growth of the mammary tree results from the elongation and branching of these ducts. Lobular differentiation is seen first in the peripheral regions of the breast and then extends centrally.

3. US Puberal Breast
The normal progression of breast development under the influence of pubertal hormones has been clinically classified by Tanner into five stages that can be correlated with characteristic US appearances and also with histologic findings.
In the first stages, the hypoechoic US central area corresponds to developing immature tubular ducts tissue and the hiperechoic US peripheral area corresponds to more mature lobular tissue.

4. TANNER STAGE I
In this prepubertal stage, in most cases US shows ill-defined hypochoic retroareolar tissue (arrows)

5. TANNER STAGE II
In this stage, a palpable subareolar bud is clinically appreciated before seeing an elevation. On US, it appears as a slightly heterogeneous retroareolar star-shaped tissue, mostly hypoechoic related to the surrounding fat (arrows) that mainly represents simple branched ducts.

6. TANNER STAGE III
In this stage, there is obvious enlargement and elevation of the entire breast. On US, hyperechoic glandular tissue is seen extending away from the retroareolar area, and a central spider-shaped hypoechoic region is noted (arrows).

7. TANNER STAGE IV
In this stage, there is areolar mounding that can be transient and may not necessarily appear. On US, in most cases, hyperechoic, periareolar fibroglandular tissue is seen, with a prominent hypoechoic central region.

8. TANNER STAGE V * *
In this stage, the contour of the mature breast is reached . On US, hyperechoic glandular tissue is found with fine scattered hipoechoic spots (arrows). There may also be increased subcutaneous adipose tissue anteriorly and within the gland (*). The hypoechoic central nodule seen in Tanner stages II, III, and IV is no longer observed.