Should You Surgically Remove An Atypical Fibroadenoma in the Breast?

Q: Should You Surgically Remove An Atypical Fibroadenoma in the Breast?

Hello： The outpatient surgical excision and pathological specimen submission is being monitored by the Changhua Hospital, Ministry of Health and Welfare.

Does an atypical fibrous cyst require surgical removal?

At the end of August, a breast ultrasound revealed a 1.4 cm fibrocystic change in the left breast.
After fine needle aspiration, it was not possible to determine whether it was a benign or malignant tumor.
The doctor mentioned it was atypical and gelatinous, and after aspiration, it appeared flatter without any malignant cells obtained.
Since the abnormal area is at the edge, the doctor believes that a core needle biopsy would not be effective.
I would like to know if, in this situation, you would recommend surgical removal or continued observation? If I choose to undergo surgery, will it cause breast deformity? Will the incision be large and noticeable? Is hospitalization generally required for cyst removal surgery? Thank you.

Annie, 30~39 year old female. Ask Date: 2020/09/24

Dr. Yu Mingchang reply Surgery

Hello: The outpatient surgical excision and pathological specimen submission is being monitored by the Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2020/09/24

More Info

When it comes to managing atypical fibroadenomas in the breast, the decision to surgically remove the lesion or continue with observation is a nuanced one that depends on several factors, including the characteristics of the lesion, patient history, and personal preferences.

Understanding Atypical Fibroadenomas
Atypical fibroadenomas are a subtype of fibroadenomas, which are benign breast tumors composed of glandular and stromal (connective) tissue. They can sometimes exhibit atypical features, which may raise concerns about the potential for malignancy. In your case, the ultrasound findings and the results from the fine needle aspiration (FNA) suggest that the lesion is atypical but not definitively malignant. The fact that the lesion has changed shape and flattened after aspiration is a positive sign, indicating that it may not be aggressive.

Surgical Removal vs. Observation
1. Surgical Removal: If the atypical fibroadenoma is causing discomfort, has atypical features, or if there is uncertainty regarding its nature, surgical removal may be recommended. This is often done to ensure that any potential malignancy is ruled out and to alleviate any concerns about future changes in the lesion. Surgical excision typically involves removing the entire lesion along with a margin of healthy tissue to ensure complete removal.

2. Observation: If the lesion is stable, asymptomatic, and there are no concerning features on imaging or biopsy, your healthcare provider may recommend a watchful waiting approach. This involves regular follow-ups with imaging studies to monitor any changes in the lesion over time.

Concerns About Surgery
- Breast Appearance: One of the common concerns regarding surgical excision is the potential for changes in breast shape or contour. However, modern surgical techniques aim to minimize scarring and maintain the natural appearance of the breast. The size of the incision and the resulting scar will depend on the size and location of the lesion, but many procedures can be performed with minimal incisions.

- Hospital Stay: Most fibroadenoma excisions are outpatient procedures, meaning you can go home the same day. The surgery is typically performed under local anesthesia, and the procedure usually lasts about 30 to 60 minutes. Recovery time is generally quick, with many patients returning to normal activities within a few days.

Recommendations
Given your situation, it would be prudent to have a detailed discussion with your healthcare provider about the risks and benefits of both surgical removal and observation. If you are leaning towards surgery, ask about the specifics of the procedure, including the expected recovery time, potential impact on breast appearance, and any other concerns you may have.

Conclusion
Ultimately, the decision should be made collaboratively between you and your healthcare provider, taking into account your comfort level, the characteristics of the lesion, and any personal or family history of breast cancer. Regular monitoring and communication with your healthcare team are essential in managing your breast health effectively. If you have further questions or concerns, do not hesitate to seek a second opinion or discuss them with your doctor.

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