FIBROADENOMA/CYST adobe acrobat pdf of 'Total Mastectomy (No Reconstruction)'

These are benign lesions encompassing a spectrum of fibrocystic changes.

FIBROADENOMA

Benign collections of breast tissue, these are most common in the 18-25 y.o. age group, but can be identified at any age. Typically in the younger population these present as a palpable mass. This can be very frightening, but simple reassurance can alleviate a patientís fears. In older women, these can show as a mass on mammogram if small and not palpable. A woman may not even know she has one since they do not cause any symptoms. In these cases, they are an incidental finding. The lesions are like normal breast tissue and do not necessarily increase a womanís risk of developing breast cancer.

Management of fibroadenomas depends on the symptoms or how it was diagnosed. If the lesion is palpable, especially in a young patient, observation may be appropriate. Excision of the breast mass can be done if the lesion is causing tenderness, psychological distress, or growing.

If the fibroadenoma is not palpable and identified only on breast imaging, further imaging or biopsy may be needed to document the tissue as a fibroadenoma. If the lesion exhibits any evidence of abnormal change or excessive growth pattern excision of the mass with wire localization may be recommended. If a biopsy is done and the lesion shown to be benign, it may be left alone for observation only. If so, then a follow-up study may be recommended in order to document itís stability

If a fibroadenoma is excised, these lesions usually do not grow back. However, there is a variant of a benign fibroadenoma, a phyllodes tumor, that is very active on a cellular level and can sometimes grow back. In these cases, future follow-up is typically recommended on an annual basis. Once again, these lesions are not cancerous.

CYST

This is the most common finding when doing breast imaging. Over 90% of women have cysts in some manner. These are small sacks of fluid within the breast. Most are very small and cannot be felt of breast examination. Only if they are large or are close to the skin surface can they be felt. Cysts can fluctuate in size/symptoms depending on the menstrual cycle or can stay the same at all times. These lesions typically DO NOT change into cancer.

A large/tender cyst may be aspirated either in the office or with ultrasound guidance if symptomatic. If the fluid is benign in appearance it is discarded. The fluid can be sent for analysis if it looks abnormal in any way or if the patient desires for their peace of mind. If a cyst is aspirated, it may recur. If a simple cyst is an incidental finding, no treatment is needed.

Occasionally, a cyst may not look completely normal on imaging, a complex cyst, in which aspiration or biopsy may be recommended to check the nature of the fluid. If normal, this can be left alone. Excision is recommended only if the aspiration of the lesion proves abnormal by cytology





 
Dr. Arlene E. Ricardo, M.D.