Breast Fibroadenoma Treatment

 Breast Fibroadenoma is a benign disease of the breast tissue. It is a non inflammatory discrete lump of a breast. Other non inflammatory causes of discrete breast lumps include ductal papilloma, benign Phyllodes, hematoma, a galactocoele or a breast cyst. Inflammatory causes of breast discrete lumps include breast abscess, periductal mastitis (an evanescent mass) or a hydatid cyst. A discrete lump in the breast is commonly a fibroadenoma in the young and a cyst in the middle aged. 

A fibroadenoma is, in fact, most common cause of a breast lump in women aged 15-25 years. It arises from hyperplasia of a lobule and usually grows to 2-3 cm in size. Any breast disease can by confidently diagnosed by an assessment technique called 'tripple assessment' in which history and clinical examination, investigations (ultrasonography and mammography) and histological investigation (fine needle aspiration cytology, core needle biopsy or an excisional biopsy) are conidered. In fibroadenoma too, a triple assessment can lead to correct diagnosis which is mostly straightaway. A mobile, well circumscribed, deep, discrete lump without any skin changes is typical of a fibroadenoma. Ultrasonography also shows a well circumscribed solid mass suggestive of fibroadenoma. If a solid mass has irregular shape and ill-defined margins or if the age is >25 years, a biopsy should be performed. 

Treatment of fibroadenomas can be medical or surgical. Anti estrogen drugs like tamoxifen and ormeloxifene have shown regression. Indications for surgical treatment include age> 30 years, suspicious features on imaging, atypia on histology, size >5cm, family history of breast cancer, pain and patient preferences.

 Surgical excision is a procedure called lumpectomy, excision or enucleation. A circumareolar incision is usually preferred. However other incisions like radial or infra mammary may be given. Fat is dissected after skin incision and lump identified by change in color. It is then held with a babcock forceps and then plane of dissection identified. Blunt or sharp dissection in an avascular plane leads to the base. Base of the lump may then be transfixed to secure bleeding from the feeding vessels. However, transfixation is usually not required for small lumps. Fat is reconstructed using absorbable sutures in order to avoid dead space and seroma formation. Subcutaneous tissue approximated. Skin is closed using subcuticular sutures.