Treatment of Symptomatic Fibroadenoma of the Breast or Fibroadenoma with Concern for Malignancy
Not every fibroadenoma requires intervention — but certain clinical features change the calculus. When a fibroadenoma is symptomatic, cosmetically distressing, growing rapidly, or raises suspicion for malignancy, a structured management plan is warranted.
Clinical Scenario
This protocol applies to patients with a symptomatic fibroadenoma, or a fibroadenoma presenting with associated atypia, unusual pathologic features, cosmetic concern, rapid growth, or clinical/radiologic suspicion for malignancy. Each of these features may prompt active management rather than observation.
Approach (Partial Overview)
Surgical excision is the primary approach for this population, performed in a manner that preserves long-term aesthetic outcomes. For select patients with biopsy-confirmed disease, image-guided minimally invasive alternatives may be considered. The full protocol specifies which approach applies to which patient — and under what conditions.
References
DOI: 10.21037/abs-20-100
- Symptomatic FA management: surgical excision
- FA management with concern for malignancy: surgical excision
- For biopsy proven FA, surgical excision should be considered if there is associated atypia, unusual pathologic features, or symptomatic/cosmetic concerns.
- If the FA is causing concern for the patient or the physician has suspicion for malignancy, surgical excision is reasonable and should be performed in an oncoplastic fashion to maximize long-term aesthetic outcomes.
- A biopsy proven FA can be safely enucleated and margins are not recommended.
- Alternatives to surgical excision exist but they should only be considered in patients with a core biopsy proven FA.