Breast fibroadenomas are non-cancerous breast tumors that are made up of stroma (fibrous connective tissue that supports the mammary gland) and adenosis (lobes that have developed hyperplasia).
Fibroadenomas can be felt during one’s monthly breast self-exam and will show up on mammograms and ultrasounds. Women in their 20s or 30s are most likely to develop a breast fibroadenoma, which may grow larger during pregnancy or breastfeeding (lactation).
Types of Fibroadenoma
There are two separate types of fibroadenomas and it's important to distinguish between these when choosing the best treatment options. People often ask if having a fibroadenoma increases the risk of developing breast cancer. With the most common types, the answer is no. Types of fibroadenomas include:
- Simple - Most fibroadenomas are the simple types—there’s usually just one of them in the patient’s breast, with a definite border and very uniform cells. A simple fibroadenoma does not raise the risk of breast cancer.
- Complex - Complex fibroadenomas are less common, and while they may have a definite border, it's what is inside this kind of fibroadenoma that makes it different. A complex fibroadenoma will not look organized and uniform like a simple fibroadenoma.
Even though complex fibroadenomas don't become cancerous, they may contain a collection of small cysts, calcifications, enlarged breast lobules, papillomas and different kinds of hyperplasia. When atypical hyperplasia occurs, however, it can raise the patient’s risk of developing breast cancer.
Diagnosis of Fibroadenoma
A breast fibroadenoma will usually feel smooth, firm and rubbery. It may move within the patient’s breast tissue when doing the breast self-exam, and it is not likely to feel painful or tender. Most of these benign lumps are between one and three centimeters (½ to 1 ½ inches), but some may grow as large as five centimeters (around 2 ½ inches).
The radiologist will be able to see a fibroadenoma on the patient’s screening mammogram, and an ultrasound will help distinguish it from a fluid-filled cyst. But the most definite way to get a diagnosis of fibroadenoma is with a breast biopsy.
Cautions associated with Fibroadenoma
It's important to point out a few cautions with fibroadenomas. These benign breast lumps are most common in women under the age of 35. In women older than age 35, a definitive diagnosis is more important. A breast biopsy is one way to do this, though a breast biopsy only samples one part of a lump.
Most of the people now know that many breast lesions, both benign and cancerous are heterogeneous. This means that the cells in one part of the tumor may be different than those in another part of the tumor.
There have been cases in which a breast biopsy has revealed a fibroadenoma, but after removal, when the entire lesion is evaluated by a pathologist, cancer has been present as well.
Treatment of Fibroadenoma
If the doctor has confirmed a diagnosis of a fibroadenoma, there are several different treatment options available. These span the spectrum from simply observing the fibroadenoma, to a lumpectomy.
There are many factors that may affect the patient’s choice of treatment. One is whether the patient is having a simple or a complex fibroadenoma. The symptoms are important as well.
Make sure that the doctor understands what the patient is experiencing so that he is on the same page. Treatment options include:
- Watch and wait is one approach. Since fibroadenomas are not always troublesome and sometimes shrink on their own, just keeping an eye on their progress is the least invasive way to handle them.
- Lumpectomy, or surgical removal of a fibroadenoma, can be done if the patient is worried about keeping it in the breast. Depending on the relative size of this lump and the patient’s breast, a lumpectomy may cause a change the breast's size or shape.
- Laser ablation is a non-surgical way to get rid of a fibroadenoma. In the surgeon's office, an ultrasound-guided laser device is used to destroy the fibroadenoma, leaving behind only a tiny scar, no sutures, and no change in breast shape. There's no general anesthesia needed and it can usually be done as a same-day surgery procedure.
- Cryoablation is a fast, efficient way to freeze a fibroadenoma. In one office visit, cryoablation simply freezes the lump so that healthy tissue can take over. This procedure takes less than 30 minutes and results in a tiny scar.
- Radiofrequency ablation (RFA) removal of fibroadenomas is another way to take an unwanted lump out of your breast without resorting to a lumpectomy. Using local anesthesia and ultrasound guidance, a six to eight-millimeter cut is made above the fibroadenoma. Through this cut, a surgical wand is inserted and then tipped by a knife that is heated by radiofrequency current. This helps cut through the breast tissue without causing much bleeding. Once it reaches the target, small wires and robotic arms capture the fibroadenoma and extract it.
- Mammotome breast biopsy systems can now be used as a fairly non-invasive way to remove fibroadenomas. In less than an hour, and under local anesthesia, a six-millimeter (1/4 inch) cut is made over the fibroadenoma. Then with ultrasound guidance, a Mammotome probe is threaded into the lump, which vacuums out sections of the tissue. Recovery is quick, and your scar will be quite small.
- High-frequency focused ultrasound (HFU) is a relatively new treatment that has been used for fibroadenomas, and sometimes, even for breast cancer. HFU can apparently cause the selective destruction of deep tissues without damaging the surrounding healthy tissue.