Breast Cysts and Adenomas: When to Seek Surgery?

Q: Breast Cysts and Adenomas: When to Seek Surgery?

Dear Wei： <br>1. <br>Principles for managing swelling and pain： (1) Determine if there is any increase in size. <br>(2) Assess for symptoms such as pain or itching that may affect daily living. <br>In either of these situations, intervention is recommended, which may include biop

Blister? Breast adenoma?

Hello, I would like to ask about a situation where I found a lump in my breast and went for an ultrasound examination.
After the examination, the doctor told me it was a cyst, which might either grow larger or disappear, but did not specify its size and advised me to return for follow-up in three months.
However, feeling uneasy, I went to another hospital for a check-up two weeks later, and the doctor there said it was an adenoma measuring approximately 1.4 cm, which would not disappear on its own, and advised me to return for follow-up in six months.
The differing opinions from the two doctors have made me very worried.
During the second examination, I felt there were two lumps, but the doctor said there was only one.
It was very obvious to me that there were two lumps, but I don't understand why they were not detected.
I read online that adenomas typically stop growing when they reach about 2 to 3 cm, and many doctors suggest that for those under 25, regular monitoring is sufficient and surgery is not necessary.
I am concerned that if I continue to monitor them, they might grow larger.
Wouldn't that result in a larger surgical wound later on? Would it be better to have surgery now while they are still small? Can the surgery remove both lumps at once? I would appreciate your guidance on this matter.
Thank you.

Wei, 20~29 year old female. Ask Date: 2016/02/16

Dr. Zhou Jiazhen reply Breast and Thyroid

Dear Wei:
1.
Principles for managing swelling and pain: (1) Determine if there is any increase in size.
(2) Assess for symptoms such as pain or itching that may affect daily living.
In either of these situations, intervention is recommended, which may include biopsy or excision.
2.
Cysts and adenomas can sometimes be difficult to differentiate on ultrasound, especially if the fluid within the cyst is somewhat turbid, as it may appear similar to an adenoma.
(At this point, it is advisable to use the term "cyst" instead of "blister.") As long as the appearance is regular, the contents are homogeneous, and there are no signs of malignant transformation, it is not necessary to determine whether it is a cyst or an adenoma; observation is sufficient.

Reply Date: 2016/02/16

More Info

When it comes to breast cysts and adenomas, understanding when to seek surgical intervention can be a source of confusion and concern for many patients. Based on your description, it seems you have encountered differing opinions from two healthcare providers regarding the nature and management of your breast lumps. This situation is not uncommon, as breast conditions can vary significantly in presentation and management recommendations.

Breast cysts are fluid-filled sacs that can develop in the breast tissue. They are often benign and can fluctuate in size, sometimes disappearing on their own. On the other hand, breast adenomas, which are benign tumors made up of glandular tissue, may not resolve spontaneously and can grow over time. The distinction between these two conditions is crucial, as it influences the management approach.

In your case, the first physician suggested that the lump was a cyst and recommended follow-up in three months, while the second physician diagnosed it as an adenoma measuring approximately 1.4 cm and advised a six-month follow-up. This discrepancy can understandably lead to anxiety, especially when you feel a second lump that the physician did not identify. It’s important to note that imaging techniques, such as ultrasound, can sometimes miss smaller lesions, particularly if they are not well-defined or if they are obscured by surrounding tissue.

Regarding your concerns about the growth of the adenoma, it is true that many adenomas tend to stabilize in size once they reach a certain point, often around 2-3 cm. However, this is not a guarantee, and some adenomas can continue to grow. Regular monitoring is a common approach, especially in younger patients under 25, as many healthcare providers prefer to avoid unnecessary surgeries unless there are significant changes in size or symptoms.

You raised an important question about the potential for larger surgical wounds if the adenomas grow larger before surgery. While it is true that larger masses may require more extensive surgical intervention, the decision to operate should be based on a combination of factors, including the size of the adenoma, any associated symptoms (such as pain or changes in breast appearance), and the overall risk of malignancy, which is generally low for benign adenomas.

If you are feeling uncertain about the management plan, it is entirely reasonable to seek a third opinion from a breast specialist or a surgeon who specializes in breast conditions. They can provide clarity on whether surgical intervention is warranted at this stage or if continued monitoring is appropriate. If surgery is indicated, it is often possible to excise multiple adenomas in a single procedure, which can minimize the need for multiple surgeries and associated scarring.

In summary, while monitoring is a valid approach for benign breast conditions, your comfort and peace of mind are paramount. If you feel that the adenomas are causing you anxiety or if they are changing in size or characteristics, discussing surgical options with a qualified specialist may provide you with the reassurance and clarity you need. Remember, proactive communication with your healthcare providers is key to managing your health effectively.

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