Fibroadenoma Surgery - Removal of Fibroadenoma and phylloides tumour
What is a fibroadenoma?
A fibroadenoma is a benign tumour that arises from the fibrous and glandular tissue of the breast. They are not dangerous and do not have the ability to spread throughout the body.
Fibroadenomas usually occur in younger patients during there childbearing years (ages 20-40), although they may occasionally occur in post-menopausal women and even in teenagers. Fibroadenomas are responsive to oestrogen and progesterone. Therefore, the incidence of fibroadenomas decreases after menopause.
In young patients a fibroadenoma is the most common cause for a breast lump.
fibroadenomas typically present as a painless, smooth and rubbery lump that is easily felt and very slowly growing. They are usually quite mobile and move easily when pressed. Because of this they are sometimes referred to as a ‘breast mouse’.
What is a Phyllodes tumour?
Phyllodes tumours are also known as a ‘fibroepithelial tumour’. They develop from the supporting tissue of the breast (compared to a breast cancer that arises from the ducts and lobules).
Phyllodes tumours have a spectrum of aggressiveness, ranging from the very benign type that can be difficult to distinguish from a benign fibroadenoma to the dangerous malignant type. Luckily the majority of phyllodes tumours (approximately 60-70%) has a benign character and has a very low chance of spreading and being dangerous. The malignant type is very rare and is extremely aggressive and warrants a mastectomy.
Phyllodes tumours tend to occur in adulthood between the ages of 40-50, and present as firm mass within the breast. They may enlarge quite quickly and a more aggressive type is suspected if the rate of growth is very rapid or the biopsy shows an aggressive subtype.
Is a fibroadenoma the same as phylloides tumour?
A Fibroadenoma and a Phyllodes tumour are not the same. The two types of tumours are not related but can present in similar fashion and also look similar under the microscope.
In general Fibroadenomas tend to occur in younger women aged (20-40), but have been reported in teenagers and the elderly. The incidence tends to reduce after menopause. This differs to Phyllodes tumours that tend to occur in patients who are post-menopause (ages 50-70) and are rarely seen in teenagers.
Both types of tumours usually present as a painless lump that may be firm and mobile. Phyllodes tend to enlarge at a faster rate then the fibroadenomas.
Fibroadenomas are benign and have no ability to spread around the body. They are not dangerous in any way. Unlike phyllodes tumours which all have the potential to spread throughout the body. Phyllodes tumours are graded as benign (low chance of spreading), intermediate risk or malignant (with a high risk of spreading).
Clinically these two tumours can be hard to distinguish and a biopsy is required to distinguish the two apart.
Why does a Phyllodes need to be removed?
Phyllodes tumours need to be removed due the underlying ability for these tumours to spread throughout the body.
60-70% of phyllodes are classified as benign have a very low chance of spreading. It is very difficult to tell benign phyllodes from malignant phyllodes pre-operatively. Therefore it is recommended that all phyllodes tumours and fibroadenomas that have atypical features are removed. Removal allows the correct grading to be made and the most definitive treatment and follow-up planned.
- Benign Phyllodes – treated with simple complete removal.
- Intermediate Phyllodes – need complete removal with a margin of normal breast tissue. These types of tumours need annual breast imaging to look for any recurrence.
- Malignant Phyllodes – Very aggressive and need a mastectomy. If you have undergone a simple excision prior a completion mastectomy will usually be recommended.
Why do I need to remove a these tumours
Fibroadenomas are benign and not dangerous. Therefore, a fibroadenoma does not necessarily have to be removed. There are certain circumstances where removal of the fibroadenoma is recommended.
- Possibility the lesion is a phyllodes tumour – if the biopsy is atypical
- The fibroadenoma is enlarging rapidly. This raises the suspicion that it is a phyllodes tumour.
- Enlargement on follow up imaging. If the fibroadenoma is growing on follow up imaging the possibility of a phyllodes is raised and removal is indicated.
- If the fibroadenoma is causing pain, removal is recommended.
- If none of the above reasons are met some patients would prefer to not have a lump within the breast. In these cases of patient concern, removal is indicated.
What is involved in surgery?
Most of the time these lumps can be removed as a day case under general anesthetic. If your lump is more likely to be a phyllodes tumour an overnight stay is most likely to be offered.
For fibroadenomas the incision will be dependent on here the lump is within the breast. The aim is to try and hide the scar as much as possible. Usually an incision around the nipple / areolar complex is used.
Phyllodes tumours often need a margin of normal breast tissue removed at the same time. This will require a slightly larger incision. The incision will be placed in a skin crease within the Bra line so as not seen if wearing a low cut top.
All wounds are closed with dissolving sutures and will be covered with a waterproof dressing.
You should be able to return to work within a few days of having the procedure performed.
What are the possible side effects?
Removal of fibroadenoma / phyllodes tumour is a common operation performed by Dr. Green for which he has been well trained. The vast majority of patients will follow the “usual” path of recovery and be discharged from hospital feeling well on the same day or the following day after their operation.
Despite this things may not always go according to plan and a small number of patients may experience a significant complication.
The information below will help you understand some of the possible problems that can result from having an operation on your breast. “Complications” are listed below. Some are common and others are less common but very important if they happen. While the following list is a guide, it is not comprehensive.
If you would like more information after your consultation and reading this page please feel free to discuss any issues with Dr Green.
COMMON (up to 10% of cases)
Uncommon (up to 5% of cases)
Rare but important (less than 1% of cases)