The majority of referring patients have one of three complaints: a mass, pain, or nipple discharge. The most common findings in the young patient are fibrocystic changes, a condition for which we have a name but little or no information regarding the descriptive or analytic epidemiology. This article outlines the evaluation and treatment of these patients, including the management of breast pain. Nonproliferative lesions, including gross cysts, are discussed, and biphasic tumors of which the fibroadenoma is most common, are covered. Several rare, but clinically important lesions are discussed, including the differential diagnosis and recommendations for treatment.