Breast fibroadenoma treatment (removal, surgery)
Breast tumors are quite common among women of all age groups and the greatest number are benign, including fibroadenoma.
With nodular formations in the breast mammalogy meet every day. Come as young girls and women, and the ladies of advanced years. The modern woman leading an active lifestyle, often do not go to the doctor, so, having had a tumor, she can postpone the visit to a specialist for an indefinitely long time. Well, if the tumor will be benign, but during the waiting it can reach large sizes or appear in it cells with signs of malignancy, and hence the treatment will be more complex.
Medical examination and ultrasonography in most cases, asymptomatic tumors shows the presence of a fibroadenoma of the breast. This tumor often affects girls and young women 20-30 years, but in more Mature age, including menopause, the tumor can also be diagnosed.
Fibroadenoma – a benign tumor of glandular origin and the prefix «fibro-» indicates a significant amount in its composition of connective tissue, giving the tumor a firm consistency. Fibroadenoma considered a variant of nodular forms of mastitis.
Often the tumor is confused with a fibroadenoma, but these processes have differences. Fibroadenoma is a localized tumor, while a fibroadenoma is characterized by proliferation of glandular and connective tissue throughout the gland. In addition, fibroadenomatosis responds well to conservative therapy, which is not observed in benign tumors.
Fibroadenoma, as a rule, is not manifested by any symptoms, and the only complaint of the patient may be the presence of nodules in the breast. Most often, the tumor is detected during self palpation of the breast or when passing preventive examination.
The types and causes of fibroadenoma
For most women, there is a single tumor nodule in one breast, although sometimes bilateral involvement. This tumor has a firm consistency, are well shifted in the feeling, painless, with clear contours, not connected with surrounding tissues. The skin in the area of growth of the neoplasia is not changed. The size of the tumor varies from several millimeters up to 7-9 cm, but usually 2-3 cm is sufficient to ensure that the woman came to the doctor.
Large tumours due to the timely detection of rarely diagnosed today. Most women before the menstruation there is some swelling of the mammary glands, which can create a false impression of tumor growth, which actually is not happening.
The basis of fibroadenoma is glandular tissue with the layers of connective, giving it a dense texture. In young women the tumor may be soft and prone to rapid growth, while women of the older generation, it increases very slowly or almost not growing, dense, with a well defined capsule (Mature fibroadenoma).
Depending on the nature of the growth and histological structure are usually distinguished:
Intracanalicular fibroadenoma, growing mainly in the lumen of the ducts;
- Peritonectomy when the tumor tissue to grow around the ducts of the gland;
- Mixed form;
- Phyllodes fibroadenoma.
Special clinical importance phyllodes fibroadenoma, having a layered structure and are prone to rapid increase. Such a tumor often diagnosed in young patients and in 10% of cases cancerous breast. Unlike other variants of the tumor, suspect leaf adenoma from its magnitude, which the neoplasia reaches for a small period of time.
Disease duration and tumor size have no clear connection with the risk of malignancy. So, cancer can develop from neoplasia in the 1-2 cm, and larger units in older women can be a long time to be completely benign. It is believed that the detection of atypical cells or atypical hyperplasia of the epithelium increases the likelihood of breast cancer in 8-9 times. The moment when the fibroadenoma become cancerous tumor can not be predicted, so experts often insist on the radical treatment of the disease.
Causes of fibroadenoma, like any other tumor continues to be debated, but it is known that a hormonal imbalance is crucial among all the other risk factors. For this reason, the tumor is often diagnosed at times of greatest hormonal fluctuation: puberty, during pregnancy and lactation, premenopausal women, especially against the background of hormone replacement therapy.
In addition to violations of hormonal background, the occurrence of fibroadenoma is highly favored
Tumor growth is influenced by female sex hormones, the surge level which is possible in adolescence, when only set the menstrual cycle in premenopausal women, when the background of gradual decline in ovarian hormone-producing functions there are periodic emissions of large amount of estrogens. If a woman decided on an abortion, she should know that a sharp drop in levels of sex hormones due to the termination of pregnancy may raise her appearance and mastopathy and fibroadenoma.
In the presence of other endocrine pathologies and dysfunction of the thyroid, adrenals, pituitary, ovaries changes the overall hormonal balance, and in half of these patients can be detected in the breast tumors.
Since fibroadenoma hormone-dependent, it is not surprising the fact of its growth during pregnancy that it is necessary to bear in mind patients who plan to have children. The tumor may reach such proportions that will result in compression of the ducts and impaired lactation, and in the worst case it will be joined by another and inflammation.
The role of hereditary factor in the development of fibroadenomas is rejected. If a woman is healthy, has a regular menstrual cycle, the tumor almost certainly does not threaten her, even if mom or grandma had such education. On the other hand, if the patient has adverse family history of breast cancer, the probability of malignancy fibroadenoma of the above, so it requires special attention mammalogy.
Video: a lecture about fibroadenoma — a medical opinion
Symptoms of fibroadenoma and methods of its detection
Symptoms of fibroadenoma of the breast can be reduced to the presence of dense nodules, visible to the naked eye at quite large sizes and palpable in the glandular tissue. The tumor is well shifted, painless, not associated with the skin. Usually the only concern of women is the very presence of a dense knot that doesn’t hurt. The most frequent localization of fibroadenomas think verkhnesolenyy quadrant of the gland.
In cases when the patient observes the changes of the skin in the projection of the tumor, retraction of the nipple or discharge from it, increase in the axillary lymph nodes, the doctor will suspect breast cancer, how external changes and destruction of surrounding tissues while fibroadenoma does not occur.
Most often, the presence of the tumor itself determines the patient by palpation. Self-examination is very important in the diagnosis of pathology of the breast, it is available to every woman and must be held at least once a month, preferably after menstruation, when the breast will not be swollen under the influence of hormones.
For diagnosis in the presence of any nodules should always go to a specialist. Mammolog will examine and propellerom gland, and often the diagnosis is exposed at this stage of the survey. In order to confirm the woman offered to undergo an ultrasound, which gives information about the location, size and structure of tumors. Ultrasound is used to distinguish a fibroadenoma from nodal mastopathy, cysts, which is very important in determining the course of treatment in the future. If necessary, ultrasound is supplemented with mammography, which is preferred in patients older.
Upon detection of nodules in the mammary gland obligatory stage of diagnosis is needle biopsy, which allows to exclude or confirm malignant neoplasia. It should be noted that this study provides only approximate results, as malignant cells in the analyzed material is simply not there. The use of a trephine biopsy gives a better chance of a correct diagnosis. The procedure is performed under local anesthesia, so afraid its not worth it. The final diagnosis is based on histological examination of tumor tissue obtained after its removal.
The treatment of fibroadenomas
The treatment of fibroadenomas, usually surgical. Because fibroadenoma is a tumor, though benign, conservative treatment is unlikely to give any effect. In some cases, when the size of tumors does not exceed 5-8 mm, can be assigned to conservative therapy for 4-6 months under control of ultrasound. A positive result is very rare and often in those cases where the mere presence of the tumor is uncertain, then there is a high probability that the patient was not a tumor, a fibroadenoma, responds well to conservative treatment. After this time should consider the option of surgical treatment until the time is missed, the tumor has reached large dimensions.
Young patients taking hormonal preparations, should be especially careful, because the hormone can accelerate the growth of the tumor, and therefore in such cases it is better to remove it. Women of menopausal age, you can offer observation with a small tumor size.
To do the surgery or not is decided by the doctor depending on the clinical situation. Offering the patient with a small tumor watchful waiting, mammolog can doom it to permanent anxiety and emotions: suddenly during follow up fibroadenoma is reborn in cancer? This is possible, and nobody will be able to pinpoint the moment when tumor cells become malignant, because even benign tumor is a kind of time bomb. Based on these positions, the majority of specialists are inclined to need surgical treatment as the only correct one.
If the diagnosis of fibroadenoma was set as the result of needle biopsy and beyond doubt, and the size of the tumor is calculated in centimeters, then one solution is to remove the tumor.
Indications for removal of fibroadenoma can be:
- The rapid growth of the tumor;
- The suspicion on the possible malignant nature of the growth;
- The absence of effect of conservative treatment;
- The leaf variant of fibroadenoma;
- Size more than 2 cm or the presence of a cosmetic defect at the smaller diameter of the tumor;
- The desire of the patient to remove the tumor;
- The planned pregnancy.
Breast physician when choosing the method of operative intervention can be assessed not only tumor characteristics, but also the age and General condition of the woman’s plans for childbearing. The desire to become pregnant and the presence of the fibroadenoma do not contradict each other. Moreover, some experts do not see the need for the removal of the tumor, especially if it is small, however, it should be borne in mind that the hormonal changes pregnant women may promote rapid growth of tumors, which during the subsequent lactation can compress ducts and obstruct the outflow of milk. Hence the risk of secondary inflammatory processes, milk stagnation and significant problems with feeding the baby.
Pregnant women are advised to remove the fibroadenoma of pregnancy over 3 months. If the tumor removed is not, then the question of its surgical treatment is to return as soon as the woman ceases to breastfeed, provided a stable course of the disease.
Fibroadenoma does not occur by itself, the reasons can be various endocrine disorders, pathology of the ovaries, genetic predisposition. Removing one node and not eliminating the root cause of the tumor, it is not necessary to wait for stable recovery, it can grow a new tumor. In this regard, patients with an established diagnosis of fibroadenoma should be treated and other related professionals – gynecologist, endocrinologist. Only after eliminating all possible risk factors of the tumor, you can count on a positive result after removal of the tumor.
So, the question of treatment is solved: need surgery. When choosing the venue, you should focus not on the price of the service and appearance of the chamber of the medical center, and on the qualifications and experience of the surgeon, the hand of which will depend on the outcome. Surgical treatment of fibroadenomas is best done in medical centers or offices, specializing in breast pathology. Most patients are concerned not only complete removal of the tumor, but subsequent a good cosmetic effect of the treatment, which is achieved by using conservative methods and the imposition of cosmetic sutures. In some cases the necessary assistance of plastic surgeons.
Today, with the breast fibroadenoma may be performed two kinds of operations:
Sectoral resection is performed in cases where the doctor cannot completely exclude the possibility of malignant transformation of tumor cells. This operation is the removal of the tumor with the surrounding tissue of the gland are 1 to 3 cm around neoplasia. Since removed significant amount of tissue, and cosmetic defect after surgery is likely to be. Can help plastic surgeons, and the patient may be prompted to implants or replacement of missing volume of the breast due to its own tissues, depending on the specific clinical situation. Sectoral resection is performed under General anesthesia.
Enucleation involves removal of only the node fibroadenoma (husking). This approach is justified in the case of proven absolute purity of the tumor. The surgery can be performed under local anesthesia. The ideal access is an incision at the border of the areola the areola of the field, then the seam will be almost invisible, and only in cases where through such incision to remove the tumor is impossible, the doctor resorted to removing through the skin and other areas cancer, on location education.
The duration of the removal of the tumor, as a rule, does not exceed an hour, and the patient can be sent home by the evening. Postoperative period runs easy and painless, the stitches will be removed 7-10 days after surgery, but it is possible and on the fifth day after the intervention.
A good cosmetic result can be achieved by applying intradermal sutures, which, after the final healing become invisible to others. If the incision was made in the skin over the tumor was sufficient to remove the largest node, then after healing may remain a small scar. To avoid this phenomenon, it is better to perform the operation when the tumor has not reached large dimensions.
Recurrence after treatment of fibroadenomas is not happening, but the tumor may grow in a different area of the breast that is associated with the presence of not eliminated the reasons for the growth of tumors. In this regard, the patient should be under steadfast attention of mammologist, gynecologist, endocrinologist.
With a significant amount of the removed tissue gland the question arises reconstructive treatment to replace the formed defect. The patient may be offered:
- Injection of hyaluronic acid with a small defect;
- The replacement of the missing volume at the expense of own fatty tissue pre-treated in a special way. Perhaps this method will soon be supplemented by the introduction of stem cell and related research is already underway;
- The installation of breast implants.
Implantation is possible only when large defects of the breast, but the woman’s desire to remove the fibroadenoma with simultaneous correction of the shape and size of the breast. In addition it is noticed that women with implants live longer and be less of a risk of cancer. Is associated not with the beneficial effect of installed dentures, and that such patients to more carefully monitor the condition of their Breasts significantly popping at the reception of mammalogy.
Pregnant women and those who are just planning to have offspring, concerned about the subsequent lactation. After surgery removal of tumor breast-feeding is possible, but when large amounts of CIN may be certain difficulties associated with the removal of a significant volume of the parenchyma of the gland. In this matter, as in the case of necessary reconstructive surgeries that can help in the early enrolment and timely removal of tumors.
Treatment without surgery, and with the help of folk remedies are still popular. Is XXI century, but prejudices about official medicine and the need for surgical care. For this reason, the morbidity and mortality from breast cancer is hardly the first place in the world, and women reach the doctor in advanced stages of the disease. I want to again remind you that no dietary Supplements, resolving means and the folk healing are not able to get rid of the tumors that can be cured only by surgery. Treatment without surgery will not give a positive result, and only will take time and the possibility of interventions.
A timely appeal to a competent and experienced specialist allows you to avoid traumatic operations, the need for plastics and the risk of malignant transformation of the tumor. After treatment, the observation by a mammologist is a must and is the key to the preservation of women’s health, the prevention of recurrent growth of benign tumors and breast cancer.