Breast abnormalities and disease are rare in the young developing breast. Malignancy is even more uncommon. Yet evaluation and management of breast disease in infants, children, and adolescents requires a conservative approach to preserve developing structures and cosmetic appearance. Diagnosing breast disease in young patients can be made more difficult by developing breast anatomy, which is denser than adult breasts. In addition, ordering physicians, radiologists, and radiologic technologists must carefully consider the use of ionizing radiation in the diagnosis and management of pediatric breast disease.