Fibroadenomas: Concerns and Surgical Options for Young Women

Breast fibroma

Hello, doctor.
I am currently abroad.
Since 2018, I have undergone ultrasound examinations that revealed multiple tumors in both breasts.
Each time I followed up, the radiologists considered them to be fibroadenomas.
In November of last year, during a follow-up, it was recommended to perform a core needle biopsy on the largest tumor on the right side.
I promptly consulted a breast specialist and underwent the biopsy, which confirmed it was a fibroadenoma.
At that time, I chose to continue monitoring it.

In late August of this year, during another follow-up, I saw the breast specialist again.
Since there were signs that the tumors were growing, I planned to surgically remove the three largest tumors, but only one of them had previously undergone a biopsy.
Although the ultrasound results over the past three years showed no significant changes in the appearance of these tumors, both the radiology and breast specialists did not recommend additional biopsies.
However, I suddenly became concerned about the possibility of cancer in the two tumors that have not been biopsied.

Doctor, what is the likelihood of this possibility? I am 24 years old.
I apologize for the lengthy question, and I truly appreciate your help.
Thank you very much.

Niming, 20~29 year old female. Ask Date: 2021/11/15

Dr. Chen Jiaming reply Surgery

The chances are slim.
You have multiple fibroadenomas in your breasts.
Since you are still young, your hormone levels are relatively high, which indeed makes fibroadenomas more likely to grow.
There has been an observed trend of growth, and medically, it is recommended to excise the larger or growing ones (which also facilitates future monitoring).
Since the other ones have already been identified (for at least over a year), if those were malignant tumors, it would be unlikely that there would be no changes after a year without treatment.

Reply Date: 2021/11/15

More Info

When it comes to fibroadenomas, especially in young women like yourself, there are several important factors to consider regarding diagnosis, management, and the potential need for surgical intervention. Fibroadenomas are benign tumors of the breast that are most commonly found in women in their teens and twenties. They are typically characterized by their firm, smooth texture and can vary in size.
In your case, you have been monitored for multiple fibroadenomas since 2018, and while they have not shown significant changes in appearance, the concern arises when there is a noticeable increase in size or changes in characteristics. The fact that you have had a core needle biopsy on one of the tumors, which confirmed it as a fibroadenoma, is a positive indicator. However, your worry about the other two tumors that have not been biopsied is understandable, especially given the natural anxiety surrounding breast health.

The likelihood of a fibroadenoma transforming into breast cancer is very low. Fibroadenomas are generally considered non-cancerous, and the risk of malignancy in these lesions is minimal. However, the decision to proceed with surgery often depends on several factors, including the size of the tumors, any associated symptoms (such as pain or discomfort), and the overall changes observed during follow-up imaging.

In your situation, since you mentioned that the largest fibroadenoma has shown signs of growth, surgical removal may be a reasonable option. The surgery typically involves excising the fibroadenoma along with a margin of normal tissue, which helps ensure complete removal and minimizes the risk of recurrence. It is essential to discuss with your healthcare provider the specific reasons for recommending surgery, including the potential benefits and risks involved.

Regarding your concern about the possibility of cancer in the two fibroadenomas that have not been biopsied, it is important to note that while any breast lump can cause concern, the vast majority of fibroadenomas remain benign. However, if there is any doubt or if the tumors continue to grow, your doctor may recommend excisional biopsy, which would allow for both removal of the tumors and histological examination to confirm their nature.

In terms of timing for surgery, it is generally advisable to avoid scheduling the procedure during your menstrual period, as hormonal fluctuations can affect breast tissue and may complicate the surgical process. Your healthcare provider will guide you on the best timing based on your menstrual cycle and overall health.

In summary, while the risk of cancer in fibroadenomas is low, your proactive approach to monitoring and considering surgical options is commendable. It is crucial to maintain open communication with your healthcare team, express your concerns, and ensure that you are comfortable with the management plan moving forward. Regular follow-ups and imaging will continue to play a vital role in monitoring your breast health. Remember, your peace of mind is important, and addressing any concerns with your physician will help you make informed decisions about your care.

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