Fibroadenoma surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ifeoma Odukwe, M.D. [2] Haytham Allaham, M.D. [3]

Overview

The majority of cases of fibroadenoma are self-limited and only require close follow-up. The feasibility of surgery depends on the age of the patient at the time of diagnosis. Surgery is the mainstay of treatment for fibroadenoma among patients older than 35 years of age. An open excision surgery can be done or a vacuum assisted ultrasound guided biopsy. Another option could be cryoablation but, it is not commonly done in fibroadenoma cases.

Surgery

Excision

  • A small and constant sized fibroadenoma confirmed by imaging studies may be managed with careful observation and follow up. The majority of cases of fibroadenoma are self-limited and only require close follow-up.[1][2]
  • The possibility of surgery depends on the age of the patient at the time of diagnosis. Patients younger than 35 should be observed with frequent clinical evaluations.[3]
  • Fibroadenomas that either do not completely regress, or remain unchanged by the age of 35, should be excised surgically.[3]
  • Surgery is the mainstay of treatment for fibroadenoma among patients older than 35 years of age, symptomatic patients and rapidly growing masses.
  • Smaller fibroadenomas may be surgically removed when the masses are nonmobile, enlarging, tender, hard, fixed to the overlying skin or nipple areolar complex, associated with axillary or supraclavicular lymphadenopathy, or the patient is experiencing excessive anxiety because of the mass.[2]
  • Some adults have been successfully treated with cryoablation, but there are few reports on its use in adolescents.[2]

Vacuum-Assisted Ultrasound Guided Biopsy

  • It involves usage of a hollow bore needle to make multiple percutaneous passes (under ultrasound or stereotactic guidance) with subsequent aspiration of the breast tissue via vacuum suction. This procedure is done in the office under local anesthesia.[4]
  • The procedure is said to be complete when the mass appears to be radiographically removed completely (judging via radiographic guidance).[4]
  • Most patients that undergo this procedure are more satisfied with the cosmetic outcome when compared to patients that undergo conventional open excision.[5]
  • There is about 30% chance of residual mass months after the procedure.[6]
  • Hemorrhage and hematoma are the most commmon complications associated with this procedure (due to serial core biopsies), occurring at a rate of 0-13%. About 4% of patients may experience moderate post-procedural pain while about 39% may experience mild post-procedural pain.[5]

References

  1. Carty NJ, Carter C, Rubin C, Ravichandran D, Royle GT, Taylor I (1995). "Management of fibroadenoma of the breast". Ann R Coll Surg Engl. 77 (2): 127–30. PMC 2502143. PMID 7793802.
  2. 2.0 2.1 2.2 Cerrato F, Labow BI (February 2013). "Diagnosis and management of fibroadenomas in the adolescent breast". Semin Plast Surg. 27 (1): 23–5. doi:10.1055/s-0033-1343992. PMC 3706050. PMID 24872735.
  3. 3.0 3.1 Greenberg R, Skornick Y, Kaplan O (September 1998). "Management of breast fibroadenomas". J Gen Intern Med. 13 (9): 640–5. PMC 1497021. PMID 9754521.
  4. 4.0 4.1 Lee M, Soltanian HT (2015). "Breast fibroadenomas in adolescents: current perspectives". Adolesc Health Med Ther. 6: 159–63. doi:10.2147/AHMT.S55833. PMC 4562655. PMID 26366109.
  5. 5.0 5.1 Lakoma A, Kim ES (2014). "Minimally invasive surgical management of benign breast lesions". Gland Surg. 3 (2): 142–8. doi:10.3978/j.issn.2227-684X.2014.04.01. PMC 4115760. PMID 25083508.
  6. Thurley P, Evans A, Hamilton L, James J, Wilson R (2009). "Patient satisfaction and efficacy of vacuum-assisted excision biopsy of fibroadenomas". Clin Radiol. 64 (4): 381–5. doi:10.1016/j.crad.2008.09.013. PMID 19264182.

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