Management and Treatment of Fibroadenosis
Fibroadenosis (fibrocystic breast disease) should be managed conservatively with observation and reassurance as first-line treatment, reserving surgical excision only for symptomatic lesions, those >2 cm, or when triple assessment cannot reliably exclude malignancy. 1, 2
Initial Diagnostic Approach
Triple assessment is mandatory before any treatment decision, consisting of:
- Clinical examination for smooth, rubbery, mobile masses 2
- Imaging: ultrasound alone in women <40 years; mammography combined with ultrasound in older women 1
- Tissue biopsy via fine-needle aspiration or core biopsy (sensitivity 84% and 98% respectively) 3
Critical caveat: Clinical diagnosis alone is unreliable and does not exclude malignancy even in younger women 1. A negative triple test result that is consistent with fibroadenoma is required before conservative management 1.
Conservative Management (First-Line)
Observation is safe and acceptable when triple assessment confirms benign disease 1, 3:
- 52% of fibroadenomas reduce in size over 5 years 3
- 16% remain unchanged 3
- No increased risk of breast cancer development 1
- Patients must be counseled about test limitations and instructed to return promptly if symptomatic or clinical changes occur 1
Medical Therapy Option
Bromocriptine 2.5 mg every 8 hours for 3 months can be considered for symptomatic relief 4:
- Provides marked relief of pain and mammary tension within days 4
- Causes nodules to become smaller and softer 4
- Improvement persists for at least 6 months after treatment cessation 4
- Suppresses prolactin levels significantly 4
Surgical Management Indications
Surgical excision should be offered when any of the following are present 2, 3:
- Symptomatic lesions causing pain or anxiety
- Diameter >2 cm
- Rapid growth rate
- Complex features on imaging
- Disease recurrence
- Patient anxiety despite reassurance
- Triple assessment inconclusive or suspicious for malignancy 1
Surgical Options by Disease Extent
For isolated fibroadenomas: Simple excision with optimal cosmesis 2
For extensive bilateral disease (multiple complex fibroadenomas): Nipple-sparing subcutaneous mastectomy with silicone implant reconstruction addresses both physical and psychological aspects 5. This approach achieved both surgeon and patient satisfaction in cases with 37+ bilateral lesions 5.
Alternative minimally invasive options include 5:
- Cryoablation
- Ultrasound-guided vacuum-assisted eradication
Follow-Up Protocol
For patients choosing conservative management:
- Reassess at minimum 5-year intervals 3
- Immediate evaluation required for any symptomatic or clinical change 1
- No carcinoma development has been documented at sites of conservatively managed fibroadenomas over 5+ years 3
Key Pitfalls to Avoid
- Never rely on clinical examination alone to exclude malignancy, regardless of patient age 1
- Do not proceed with observation unless triple assessment is complete and concordant 1
- Avoid unnecessary surgery for asymptomatic lesions <2 cm with benign triple assessment, as >50% will spontaneously regress 3
- Recognize that 4% of presumed fibroadenomas may represent other benign pathology on histology 3