Breast fibroadenoma is a common benign lesion resulting from stromal and epithelial tissue growth in the breast. Fibroadenomas largely occur in young women and account for over half of all breast masses in adolescents.
Breast fibroadenoma is a benign lesion and arises from the proliferation of the breast tissue. Fibroadenomas occur at any age, but more so in women below the age of 30 years. There are different types, namely simple, giant juvenile, and multicentric fibroadenomas. Women who have a history of fibroadenomas have an increased risk of developing breast cancer . Conversely, fibroadenomas in themselves have little chance (up to 0.125%) of undergoing malignant change . Younger women, those with a history of a breast mass, and women of African descent are at a greater risk for developing fibroadenomas. Protective factors include the use of combined oral contraceptive pills and greater parity.
The majority of women have simple fibroadenomas and present with a single painless, smooth, mobile breast mass with a rubbery consistency, most often located in the upper outer quadrant. The average size of lesions is about 2-3 centimeters.
10%–25% of affected women have multicentric fibroadenomas . These can occur in any quadrant of the breast. Giant juvenile fibroadenomas make up between 0.5% and 2% of all fibroadenomas  . They are typically seen in adolescent girls, and are usually unilateral and grow rapidly, with a weight of more than 500 grams or diameter over 5 cm. They cause distortion and displacement of surrounding breast tissue, and may even cause skin changes and a distension of superficial veins .
The size of fibroadenomas may fluctuate, with a general tendency to decrease over time. They may enlarge or shrink in response to hormonal changes during the menstrual cycle and are particularly sensitive to estrogen . Up to 40% of all fibroadenomas in adolescents resolve spontaneously.
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The majority of women have simple fibroadenomas and present with a single painless, smooth, mobile breast mass with a rubbery consistency, most often located in the upper outer quadrant. [symptoma.com]
The patient subsequently underwent excision of bilateral breast masses and reduction mammoplasty. Histopathologically, bilateral breast masses were confirmed to be juvenile fibroadenomas. [ncbi.nlm.nih.gov]
Low-risk palpable breast masses removed using a vacuum-assisted hand-held device. Am J Surg 2003; 186 (4) 362-367 10 Wang ZL, Li JL, Su L, Zhang YF, Tang J. [doi.org]
Triple assessment may be used to investigate breast fibroadenoma. This includes clinical examination, imaging, and biopsy. It is important to take a full gynecological history, as well as the history of the presenting mass. A family history should also be taken, with emphasis on breast masses and malignancies. Physical examination of the breasts and axillary lymph nodes is mandatory in determining the characteristics of the mass.
Medical imaging modalities are a major part of the assessment of breast masses. Ultrasonography is widely used, especially in young women, and is advantageous when examining this population as they have dense breast tissue . Mammography may be done and is especially advised for women over the age of 35 years. Magnetic resonance imaging (MRI) scanning is also useful and is a more sensitive test than mammography . Follow up visits for repeated imaging is indicated for fibroadenomas .
Biopsy does not always need to be performed, especially when imaging suggests fibroadenoma, and in women in their 20s or younger. In postmenopausal women, however, breast lesions should be biopsied because of the greater chance of malignancy. Giant juvenile fibroadenomas should also be biopsied, as they resemble malignancies.
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