Treatment of Fibroadenomas of the Breast
Fibroadenomas can be managed conservatively with observation in most cases, but surgical excision is recommended for fibroadenomas that are larger than 2-2.5 cm, rapidly growing, causing symptoms, have complex features, or when there is patient anxiety about the mass. 1, 2
Diagnostic Approach
- Initial evaluation should include ultrasound for all ages, with mammography added for women ≥30 years 1
- Core needle biopsy is preferred over fine needle aspiration for definitive diagnosis due to better sensitivity, specificity, and histological grading 1
- Triple assessment (clinical examination, imaging, and tissue biopsy) is essential to confirm diagnosis and exclude malignancy 3
Management Algorithm
Conservative Management (Observation) is Appropriate When:
- Fibroadenoma has benign features on ultrasound (BI-RADS 2 or 3) 1
- Core biopsy confirms definitive diagnosis of fibroadenoma 1
- Size is less than 2 cm 4, 2
- No rapid growth or concerning clinical features 1
- Patient is comfortable with observation 1
Surgical Excision is Recommended When:
- Size is greater than 2-2.5 cm 4, 2
- Rapid growth is observed 2
- Mass is immobile or poorly circumscribed 4
- Patient is over 35 years of age with suspicious features 4
- Biopsy is not definitively diagnostic of fibroadenoma 4
- Suspected phyllodes tumor (which can mimic fibroadenoma) 5, 1
- Patient experiences anxiety about the mass 1, 2
Surgical Approach
- Lumpectomy or partial mastectomy with tumor-free margins is the recommended surgical approach 1
- For suspected phyllodes tumors, wider margins (≥1 cm) are recommended 5
- Axillary lymph node dissection is not necessary unless lymph nodes are clinically abnormal 5
Alternative Treatment Options
- Ultrasound-guided vacuum-assisted biopsy (UGVAB) can serve as both diagnostic and therapeutic for fibroadenomas smaller than 2 cm 6, 7
- Complete excision with UGVAB is achievable for lesions ≤1.5 cm, with partial success (55%) for lesions 1.5-2.0 cm 6
- Recurrence rates after UGVAB are higher for fibroadenomas larger than 2 cm (33% actuarial recurrence rate at 59 months) 7
Post-Treatment Follow-up
- If pathology confirms benign fibroadenoma, routine breast screening is recommended 1
- If pathology reveals atypical features, follow appropriate risk reduction guidelines 1
Important Considerations
- Distinguishing between fibroadenoma and phyllodes tumor can be difficult with imaging or even core biopsy 1
- Fibroadenomas are not associated with significant increased risk of breast cancer 3
- Patient anxiety is a valid indication for excision according to multiple guidelines 1, 2
- Fibroadenomas larger than 2 cm treated with UGVAB require additional surveillance due to higher recurrence rates 7