The incidence of serious breast pathology in children and adolescents is low. Despite this, children, adolescents, and their parents come to the primary care provider with many breast-related concerns. Tanner staging is a good predictor of ensuing physical sexual development and can be used as a tool to reassure the pubertal girl that she is normal. Variations such as polythelia, premature thelarche, gynecomastia, nipple irritation from exercise, and nipple piercing and tattooing can be managed with education and reassurance. Whereas breast cancer is extremely rare in adolescents, evaluation with ultrasonography may be indicated. The primary care provider plays a central role in educating young girls and adolescents about healthy breast practices such as avoidance of alcohol and cigarette smoking, exercise, low-fat diet, breast self-examination, and avoidance of piercing and tattooing.