Pseudoangiomatous stromal hyperplasia (PASH) is a benign breast pathology, ranging from focal microscopic findings to clinical and mammographically evident masses, characterized by abnormal proliferation of the mammary stroma. Hormonal factors contribute probably to this pathology, since the average age of patients has been reported to be 40 years and can occur in postmenopausal patients who are on hormone replacement therapy. Notwithstanding, the etiology remains unclear and controversial. Usually, it is characterized by solitary, mobile, and slow-growing nodules. Notwithstanding, it may also occur as nodules or diffuse masses with rapid growth, simulating a malignant tumor. The recommended treatment is a wide excision of the lesion, with adequate free margins of resection, avoiding local recurrences. Herein, authors present a rare case of PASH in a 14-year-old patient, that produced severe breast deformity and assymetry. After complete excision, the breast was reconstructed by applying concepts of vertical scar breast reduction to restore breast symmetry. Level of Evidence: Level V, therapeutic study.