Fibroadenoma

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Clinical Features
Fibroadenomas are common benign breast lumps that occur in younger women. The most frequent age of developing new fibroadenomas is between 20 and 35 years. They are very slow growing and become noticeable as discrete lumps within the breast. As fibroadenomas are uncommon after the menopause, the aetiology may be hormone related.

Small fibroadenomas under 1 cm are asymptomatic and occur in many women who do not know that they are there. These are often detected as an incidental finding as a result of a test such as a mammogram or an ultrasound. Symptomatic fibroadenomas that are clinically obvious, usually measure between 1 cm and 3 cm, and form the largest group of these benign lumps presenting at a breast clinic.

Fibroadenomas form breast lumps that are very mobile. For this reason, they have been nicknamed 'breast mice'. Fibroadenomas may be multiple and up to twenty per cent of these may be found either at the same time, or subsequent to when the first lump is detected in your breast.

Under the microscope, fibroadenomas consist of a fibrous component and a glandular (adenoma) component, hence their name. These growths are benign and do not increase the risk of developing breast cancer in the future.

Clinical Management
Clinical examination, ultrasound scan and fine needle aspiration usually make the diagnosis for cytology. Over the age of 35 years, a mammogram is also routinely performed to assess the lump. If all these modalities of assessment confirm a benign fibroadenoma, a conservative approach is usually adopted. This is because many fibroadenomas after the initial growth phase do not become larger, and up to one third may even regress. Follow-up of the lump at a defined time interval, usually between six weeks and three months after initial assessment, enables objective evaluation as to whether there is a difference in size.

New fibroadenomas that form in women over the age of 40 years should be removed even if clinical examination and special investigations indicate that the lump is benign. This is because new fibroadenomas are not common over the age of 40 years, and the risk of breast atypical features within a new lump, increases with age.

If there is any uncertainty about the innocent nature of the lump, surgical removal is recommended to confirm its nature, irrespective of age. The lump will then be carefully evaluated under the microscope after its excision. A breast lump should also be removed if it is growing significantly in size. Another important reason for surgical removal is if you do not like having the lump in your breast, even if all the tests indicate that this is a benign fibroadenoma.

In considering whether to remove a fibroadenoma or not in the absence of a specific indication you should bear the following in mind. Even though cosmetic incisions are chosen to minimise any scarring, removing the fibroadenoma may merely result in exchanging the lump for a scar. This is particularly so if there are multiple fibroadenomas in the breast. A further consideration is that another fibroadenoma may form within the same or opposite breast in the future.

Fibroadenomas greater than 3 cm are usually excised, as there is a higher risk of lumps of this size containing atypical features.

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