Fibroadenoma of the breast is a benign (noncancerous) tumor.

Fibroadenoma is the most common benign tumor of the breast and the most common breast tumor in women under age 30. Fibroadenomas are usually found as single lumps, but about 10 - 15% of women have several lumps that may affect both breasts.

Black women tend to develop fibroadenomas more often and at an earlier age than white women. The cause of fibroadenoma is not known.

Lumps may be:

• Firm
• Moveable
• Painless
• Rubbery

They should have smooth, well-defined borders. They may grow in size, especially during pregnancy. Fibroadenomas often get smaller after menopause (if a woman is not taking hormone replacement therapy).

After a careful physical examination, one or both of the following tests are usually done to determine further information:

• Breast ultrasound
• Mammogram

A biopsy is needed to get a definite diagnosis. Core needle biopsy is most often performed. For more information on the different types of breast biopsies see:

• Breast biopsy - sterotactic
• Breast biopsy - ultrasound (core needle)
• Breast biopsy - open

Note: Women in their teens or early 20s may not need a biopsy if the lump goes away on its own.

A biopsy is needed to get a definite diagnosis. Women in their teens or early 20s may not need a biopsy if the lump goes away on its own.

If a biopsy indicates that the lump is a fibroadenoma, the lump may be left in place or removed, depending on the patient and the lump. If left in place, it may be watched over time with:

• Mammograms
• Physical examinations
• Ultrasounds

The lump may be surgically removed. The decision depends on the features of the lump and the patient's preferences.

Alternative treatments include removing the lump with a needle and destroying the lump without removing it (such as by freezing, in a process called cryoablation).

The outlook is excellent, although patients with fibroadenoma have a slightly higher risk of breast cancer later in life. Lumps that are not removed should be checked regularly by physical exams and imaging tests, following the doctor's recommendations.

If the lump is left in place and carefully watched, it may need to be removed at a later time if it changes, grows, or doesn't go away.

In very rare cases, the lump may be cancerous and you may need further treatment.

Call your health care provider if:

• You have a lump and it changes
• You feel a new breast lump
• You have changes in the breast that are not affected by the menstrual cycle

Perform regular breast self-exams and undergo breast screening as recommended by your health care provider.

Iglehart JK, Smith BL. Diseases of the breast. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 34.

Valea FA, Katz VL. Breast diseases: diagnosis and treatment of benign and malignant disease. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 15.

It may not be breast cancer, but irritation (bruised irritation) from the underwire. Odds are that it is irritation. You may want to put band-aidsor something soft under the wire. Or even get a few different, more comfortable bras.

A lump under the breast is always concerning if it is under the skin. Even if it is not breast cancer, it could be an early abscess or fibroadenoma. Make an appointment with you doctor or local comprehensive breast center for any breast lump that is new and non-resolving.

Tip:

Try using dental wax such as the kind used for braces, retainers, etc. Simply place between the underwire and skin to prevent irritation and pressure.

Try sprinkling a little baking soda in the bottom of your bra on a warm day to prevent the growth of fungus and bacteria. Always change a bra that has become damp from exercise. Washing bras frequently will discourage germs from growing.

If you repeatedly get rashes or redness with a new or specific bra consider that you may have developed an allergy to latex or nickel. See a doctor for symptom relief.

If you skin becomes torn, apply Tagaderm to clean dry skin to prevent further damage.

Um adenoma é uma coleção de crescimentos (-oma) de origem glandular. Os adenomas podem crescer de muitos órgãos inclusive o cólon, adrenal, hipófise, tiróide, etc. Estes crescimentos são benignos, embora com o passar do tempo eles podem progredir e ficar malignos. Nesse estágio, eles são chamados adenocarcinomas. Embora os adenomas sejam benignos, eles têm o potencial para causar complicações de saúde sérias comprimindo outras estruturas (efeito de massa) e produzindo quantias grandes de hormônios de uma maneira desregulada (síndrome paraneoplástica).

Enquanto algum adenomas adrenais não secretam hormônios, alguns secretam cortisol, causando síndrome de Cushing, aldosterona que causa a síndrome de Conn, ou andrógeno que causam hiperandrogenismo.

O fibroadenomaé o tumor benigno mais comum da mama feminina e ocorre durante a idade fértil. É composto por estroma fibroso e glândulas. Alguns fibroadenomas correspondem a hiperplasias, mas muitos são neoplasias benignas verdadeiras, originadas no estroma intralobular da mama. Nestes casos, as células da parte conjuntiva do tumor são monoclonais, as da parte epitelial são policlonais. Isto indica que estas últimas não são propriamente neoplásicas, mas proliferam em resposta a estímulos químicos secretados pelas células do estroma. (Durante muito tempo se pensou que o fibroadenoma era um tumor misto com duas linhagens de células neoplásicas; hoje isto não é mais aceito).

O tumor forma um nódulo bem delimitado do tecido mamário adjacente, notando-se uma delicada cápsula fibrosa. Na microscopia, o componente epitelial forma túbulos ramificados e dilatados, em meio ao estroma. Comparar com o tecido mamário vizinho, onde as glândulas se organizam em lóbulos, o que não ocorre no fibroadenoma. No fibroadenoma, o estroma é frouxo, composto por células estreladas separadas por material intersticial levemente basófilo. O aspecto lembra o do estroma intralobular do lóbulo mamário normal, onde o tumor se origina. No componente epitelial do fibroadenoma pode-se observar a dupla população celular (células epiteliais e mioepiteliais) como no tecido mamário normal. As células epiteliais secretam o leite (nos lóbulos) ou o conduzem (nos ductos). As células mioepiteliais são contráteis, ajudando a extrusão do produto. A dupla população é um importante elemento a favor da benignidade do tumor, pois mostra que as células se diferenciam em dois tipos topograficamente relacionados entre si. Num tumor maligno as células tendem a ser indiferenciadas, isto é anárquicas, sem relações topográficas ou funcionais definidas umas com as outras. Ver a este respeito a lâmina de carcinoma da mama

Breast ultrasound uses sound waves that cannot be heard by humans to look at the breast.

Ultrasonography of the breast; Sonogram of the breast

You will be asked to undress from the waist up and put on a medical gown. During the test, you will lie on your back on the examining table.

A water-soluble gel is placed on the skin of the breast. A hand-held device (transducer) directs the sound waves to the breast tissue. The transducer is moved over the skin of the breast to create a picture that can be seen on a screen.

Breast ultrasound may also be used to guide a needle during a breast biopsy.

Because you need to remove your clothing from the waist up, it may be helpful to wear a two-piece outfit. On the day of the test, do not use any lotions or powders on your breasts or wear deodorant under your arms.

The number of people involved in the test will be limited to protect your privacy.

You will be asked to raise your arms above your head and turn to the left or right as needed.

There is no discomfort from the ultrasound.

Common uses of ultrasound are:

• In addition to a mammogram or physical exam, if something abnormal is found. If a mammogram shows a growth, ultrasound can help determine whether it is a solid mass or a cyst.
• By itself, to check a breast lump or nipple discharge

Normal breast tissue.

Normally, the breast tissue will be uniform and will not have any suspicious growths.

Ultrasound can help show noncancerous growths such as cysts, fibroadenomas, or lipomas. A cyst is a fluid-filled sac. A fibroadenoma is a noncancerous solid growth. Lipomas are noncancerous fatty lumps that can occur anywhere in the body, including the breasts.

Breast cancers can also be seen with ultrasound.

There are no risks associated with breast ultrasound. There is no radiation exposure.

Kim CH, Bassett LW. Imaging-guided core needle biopsy of the breast. In: Bassett LW, Jackson VP, Fu KL, Fu YS, eds. Diagnosis of Diseases of the Breast. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2005:chap 17.

Breast mass

Normal breast tissue is present in both males and females of all ages. This tissue responds to hormonal changes and, therefore, certain lumps can come and go.

Breast lumps may appear at all ages:

• Infants may have breast lumps related to estrogen from the mother. The lump generally goes away on its own as the estrogen clears from the baby's body. It can happen to boys and girls.
• Young girls often develop "breast buds" that appear just before the beginning of puberty. These bumps may be tender. They are common around age 9, but may happen as early as age 6.
• Teenage boys may develop breast enlargement and lumps because of hormonal changes in mid-puberty. Although this may distress the teen, the lumps or enlargement generally go away on their own over a period of months.
• Breast lumps in an adult woman raise concern for breast cancer, even though most lumps turn out to be not cancerous.

Lumps in a woman are often caused by fibrocystic changes, fibroadenomas, and cysts.

Fibrocystic changes can occur in either or both breasts. These changes are common in women (especially during the reproductive years), and are considered a normal variation of breast tissue. Having fibrocystic breasts does not increase your risk for breast cancer. It does, however, make it more difficult to interpret lumps that you or your doctor find on exam. Many women feel tenderness in addition to the lumps and bumps associated with fibrocystic breasts.

Fibroadenomasare noncancerous lumps that feel rubbery and are easily moveable within the breast tissue. Like fibrocystic changes, they occur most often during the reproductive years. Usually, they are not tender and, except in rare cases, do not become cancerous later. A doctor may feel fairly certain from an exam that a particular lump is a fibroadenoma. The only way to be sure, however, is to remove or biopsy it.

Cysts are fluid-filled sacs that often feel like soft grapes. These can sometimes be tender, especially just before your menstrual period. Cysts may be drained in the doctor's office. If the fluid removed is clear or greenish, and the lump disappears completely after it is drained, no further treatment is needed. If the fluid is bloody, it is sent to the lab to look for cancer cells. If the lump doesn't disappear, or recurs, it is usually removed surgically.

Other causes of breast lumps include:

• Milk cysts (sacs filled with milk) and infections (mastitis), which may turn into an abscess. These typically occur if you are breastfeeding or have recently given birth.
• Breast cancer, found on mammogramor ultrasound, then a biopsy. Men also can get breast cancer.
• Injury -- sometimes if your breast is badly bruised, there will be a collection of blood that feels like a lump. These lumps tend to get better on their own in a matter of days or weeks. If not, your doctor may have to drain the blood.
• Lipoma -- a collection of fatty tissue.
• Intraductal papilloma -- a small growth inside a milk duct of the breast. This often occurs near the areola, the colored part of the breast surrounding the nipple, in women ages 35-55. It is harmless and often cannot be felt. In some cases the only symptom is a watery, pink discharge from the nipple. Since a watery or bloody discharge can also be a sign of breast cancer, your doctor should check this.

For fibrocystic changes, birth control pills are often helpful. Other women are helped by:

• Avoiding caffeine and chocolate
• Limiting fat and increasing fiber in the diet
• Taking vitamin E, vitamin B complex, or evening primrose oil supplements

Call your doctor if:

• The skin on your breast appears dimpled or wrinkled (like the peel of an orange)
• You find a new breast lump during your monthly self-exam
• You have bruising on your breast, but did not experience any injury
• You have nipple discharge, especially if it is bloody or pinkish (blood-tinged)
• Your nipple is inverted (turned inward) but normally is not inverted

Also call if:

• You are a woman, age 20 or older, and want guidance on how to perform a breast self-examination
• You are a woman over age 40 and have not had a mammogram in the past year

Your doctor will get a complete history from you, with special attention to factors that may increase your risk of breast cancer. The health care provider will perform a thorough breast examination. If you don't know how to perform breast self-examination, ask your health care provider to teach you the proper method.

Medical history questions regarding breast lumps include:

• When and how did you first notice the lump?
• Do you have other symptoms such as pain, nipple discharge, or fever?
• Where is the lump located?
• Do you do breast self-exams, and is this lump a recent change?
• Have you had any type of injury to your breast?
• Are you taking any hormones, medications, or supplements?

Tests that may be performed include:

• Biopsy of the lump
• Mammogram
• MRI
• Needle aspiration of a cyst and examination of the fluid under a microscope
• Study of nipple discharge under a microscope
• Ultrasound to see if the lump is solid or a cyst

Treatment of a breast lump depends on the cause. Solid breast lumps are often removed surgically. Cysts can be drained. Breast infections require antibiotics. If breast cancer is diagnosed, most women receive surgery, radiation, chemotherapy, or hormonal therapy. Discuss these options carefully and thoroughly with your doctor.

If you have a family history of breast cancer, your doctor may also suggest testing for genes that make you more likely to get breast cancer.

Breast cancer screening is an important way to find breast cancer early, when it is most easily treated and cured.

• Get regular mammograms.
• If you are over age 20, consider doing a monthly breast self-exam (See: Breast self exam)
• If you are over age 20, have a complete breast exam by your provider at least every 3 years -- every year if you are over 40.

Having fibrocystic breast tissue, mastitis, or breast tenderness related to PMS does NOT put you at greater risk for breast cancer. Having fibrocystic breasts does, however, make your self-exam more confusing, because there are many normal lumps and bumps.

To prevent breast cancer:

• Exercise regularly
• Reduce fat intake
• Eat lots of fruits, vegetables, and other high fiber foods
• Do not drink more than 1 or 1 1/2 glasses of alcohol a day

Saslow D, Boetes C, Burke W, et al. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 2007;57(2):75-89.

Marchant DJ. Benign breast disease. Obstet Gynecol Clin North Am. 2002;29(1):1-20.

Klein S. Evaluation of palpable breast masses. Am Fam Physician. 2005;71(9):1731-1738.

• abstinence - not having sexual intercourse.
• spermicides - foams or creams placed inside the vagina to kill sperm;
• male condoms - a thin tube made of latex, plastic, or a natural material that is placed over the penis. The sperm is collected in the end of the condom. Latex condoms may provide some protection against sexually transmitted diseases.
• female condoms - a liner made of latex or natural material that is placed inside the vagina. Latex condoms may provide some protection against sexually transmitted diseases.
• natural family planning - timing intercourse to avoid "fertile" days using various methods of monitoring body temperature, watching for changes in cervical mucus, and the use of ovulation prediction kits. This method, often known as the "rhythm" method, has a high risk for pregnancy.

Some methods that require a visit to your health care provider for an examination and a prescription include the following:

• oral contraceptives (birth control pills) - medications taken daily that prevent ovulation by controlling pituitary hormone secretion. Usually, oral contraceptives contain the hormones estrogen and progestin.

  In addition to prevention of pregnancy, oral contraceptives have several health benefits including regulating menstrual cycles and decreasing the amount and length of menstrual periods. This can help increase iron stores in women with iron deficiency associated with excessive bleeding. Prevention of certain ovarian and endometrial cancers is a significant benefit of the use of oral contraceptives. Some research has found that some benign (non-cancerous) breast diseases, including fibroadenoma and cystic changes, occur less frequently with the use of oral contraceptives. Recent studies have also suggested that oral contraceptive use may reduce the occurrence of severe disabling rheumatoid arthritis.

• mini-pill - unlike the traditional birth control pill, the mini-pill has only one hormone, progestin. Taken daily, the mini-pill thickens cervical mucus and prevents the sperm from reaching the egg. The mini-pill also can decrease the flow of your period and protect against PID and ovarian and endometrial cancer.
• Nexplanon- capsule containing the synthetic hormone levonorgestrel, implanted under the skin in the upper arm of a woman, which continuously prevent the ovaries from releasing an egg for up to three years. Local anesthesia (like novocaine at the dentist) is required for insertion and removal of this type of birth control.
• Depo-Provera - a progesterone-like drug given by injection to prevent pregnancy by stopping ovulation. The effects last for about three months and another injection must be given to continue birth control effectiveness.
• patch - this is a skin patch worn on the body that releases the hormones estrogen and progestin into the bloodstream. It is most effective in women who weigh less than 200 pounds.
• diaphragm or cervical cap - a dome-shaped rubber cup with a flexible rim that is inserted through the vagina to cover the cervix. This type of birth control must be inserted prior to having sexual intercourse.
• hormonal vaginal contraceptive ring - a ring that is placed inside the vagina . The ring releases the hormones estrogen and progestin.
• intrauterine device (IUD) - devices placed in the uterus through the cervix by a physician. The IUD works by preventing an egg from being fertilized in the tubes or from attaching to the wall of the uterus. IUDs containing hormones must be replaced every five years, while copper IUDs can last up to 10 years.
• nonsurgical sterilization - a thin tube is used to thread a tiny, spring-like device through the vagina to the uterus into each fallopian tube. A material in the device causes scar tissue to develop and permanently plug the tubes.

Birth control options range from abstinence to permanent surgical sterilization, but there are plenty of options in between. Condoms, spermacides, diaphragms birth control pills and patches, and the "morning after pill" require thought every day or every time. Depo-provera shots, implants, NuvaRing and IUDs can prevent pregnancy for months or even years at a time.

Breast lump removal is surgery to remove a lump in the breast and some surrounding tissue from the breast.

Lumpectomy; Wide local excision; Excisional biopsy; Limited breast surgery; Segmental mastectomy: Breast conservation therapy or surgery; Tylectomy; Breast sparing surgery; Partial mastectomy; Segmental breast excision

Breast lump removal is usually done in an outpatient clinic. You will be given general anesthesia (asleep, but pain free) or local anesthesia (awake, but sedated and pain free). The procedure takes about 1 to 2 hours.

The surgeon makes a small incision (cut) on your breast. The surgeon then removes some of the lump and breast tissue around it.

• If the lump is not breast cancer, your surgeon will not remove very much breast tissue from around the lump.
• If you have breast cancer, the amount of breast tissue around the lump the surgeon removes may depend on what type of breast cancer you have.
• The surgeon will close the skin with stitches. These may dissolve or need to be removed later. A drain tube may be placed to remove excess fluid.

Your doctor will send the lump to a laboratory for testing.

If you have a lump with breast cancer in it, your surgeon will also remove lymph nodes in your axilla (armpit). This will be done through another surgical cut underneath your arm. The lymph nodes will also be tested for cancer. This is called staging. Staging helps your doctor plan your treatment.

Lumpectomy is performed to either diagnose or treat an abnormal spot in the breast. Before a lumpectomy, your doctor will have done a needle biopsy and imaging tests (such as mammography) to see if you have breast cancer.

If a needle biopsy showed that you have breast cancer, your doctor will have you take more tests to see if the cancer has spread.

• Treatment depends on the type of breast cancer, if the cancer has spread, and to where, your age, whether you have reached menopause, and your overall health.
• For some breast cancer, mastectomy may be better treatment. For other breast cancer, lumpectomy (breast conservation therapy) may treat your cancer. Your doctor will help you decide what treatment is best for you.

Other reasons to perform a lumpectomy are:

• If you have fibroadenoma or other benign tumors of the breast.
• If you have a fluid-filled lump (cyst). Your doctor will first use a needle and syringe to drain fluid from the cyst. If the fluid is clear or green, is not bloody, and the cyst disappears when drained, nothing further needs to be done. If the fluid is bloody, your doctor will send it to a laboratory for testing. If you still have a lump after your doctor drains the cyst, you will need surgery to remove it. You will also need surgery if the cyst disappears after it is drained but then later returns.

Risks for any surgery are:

• Bleeding
• Infection
• Reactions to medications

Risks for this procedure are:

• Since a lumpectomy removes part of the breast, the appearance of your breast may change. After surgery, you may notice dimpling, a scar, or a difference in shape between the two breasts.
• Some microscopic pieces of the lump may be left behind after surgery. If this happens, they will need to be removed in another operation.
• You may also have numbness in the breast area.

Always tell your doctor or nurse:

• If you could be pregnant
• What drugs you are taking, even drugs or herbs you bought without a prescription

During the days before the surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), clopidogrel (Plavix), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your doctor which drugs you should still take on the day of the surgery.
• Always try to stop smoking. Your doctor or nurse can help.

On the day of the surgery:

• You will be asked not to drink or eat anything after midnight the night before the surgery.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive for the procedure.

The recovery period is very short for a simple lumpectomy. You should have little pain. If you do feel pain, you can take pain medicine, such as acetaminophen (Tylenol). Most women can resume their usual activities in a week or so. The skin should heal in about a month.

You will need to take care of the incision area. Change dressings as your doctor or nurse tells you to. Watch for signs of infection when you get home (such as redness and swelling).

You may need to empty a fluid drain a few times a day for 1 to 2 weeks. Your doctor will remove the drain later.

Avoid heavy lifting or jogging for 1 to 2 weeks. Your doctor will show you special exercises to prevent arm stiffness and talk to you about clothing and bra options, if necessary.

You may notice slight scarring.

If cancer is found, you will need to schedule follow-up treatment with your doctor.

The outcome of a lumpectomy depends on the type of lump your doctor finds, and whether or not it is cancerous.

A lumpectomy for breast cancer is often followed by radiation therapy, chemotherapy, or hormone therapy. This usually results in the same long-term survival as a mastectomy, depending on the type and how much breast cancer you have.

Women usually do not need breast reconstruction after lumpectomy.

Iglehart JK, Smith BL. Diseases of the breast. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery, 18th ed. St. Louis, Mo: WB Saunders; 2008:chap 34.

Khatcheressian JL, Wolff AC, Smith TJ, Grunfeld E, Muss HB, Vogel VG, et al. American Society of Clinical Oncology 2006 update of the breast cancer follow-up and management guidelines in the adjuvant setting. J Clin Oncol. 2006;24(31):5091-5097.

Abeloff MD, Wolff AC, Weber BL, Zaks TZ, Sacchini V, McCormick B. Cancer of the breast. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG, eds. Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 95.