Makindo Medical Notes

Related Subjects: | Assessment of the Causes of Breast Tenderness/Pain (Mastalgia) | BRCA Genes (Familial Breast Cancer) | Breast Anatomy and Examination (OSCE) | Breast Cancer | Breast Fibroadenoma | Breast Lumps: Clinical Approach | Mastitis and Breast Abscess

Breast fibroadenoma is a common benign breast tumour in young women 👩‍🦰. Most cases are harmless ✅, but reassurance and monitoring are important to reduce anxiety 😟 and ensure safe breast health.

📖 About Breast Fibroadenoma

The most common benign breast tumour, fibroadenomas typically affect women aged 15–30 👩. These “breast marbles” are made of glandular + stromal tissue 🧬. They are benign ✅ but can mimic more sinister lumps ⚠️, prompting referral.

⚙️ Aetiology

• 🔄 Hormonal influence: imbalance between breast growth & regression cycles.
• 🧬 Composition: Glandular + stromal tissue.
• 🗂️ Classification:
  • ✅ Simple: Smooth, mobile, solitary.
  • ⚠️ Complex: May contain cysts, calcifications, sclerosing adenosis → slightly ↑ cancer risk.

👩‍⚕️ Clinical Presentation

• 🎯 Age: 15–30 years, most common.
• 📉 Natural history: Shrinks post-menopause.
• 🪙 Typical features:
  • Firm / rubbery consistency.
  • Well-defined, round/oval.
  • Freely mobile within tissue (“marble-like” 🏐).
  • Usually painless 😌.
  • Single or multiple.
• 🚫 No red flags: No nipple discharge, skin dimpling, or retraction.

🧾 Differential Diagnosis

• 💧 Cyst: Softer, fluid-filled, may be tender.
• 🦀 Breast cancer: Hard, irregular, fixed, skin/nipple changes ⚠️.
• 🌱 Phyllodes tumour: Larger, rapidly growing, can be benign/malignant.
• 🤕 Fat necrosis: Post-trauma, firm, cancer mimic.
• 🟢 Intramammary lymph node: Benign palpable node.

🔍 Investigations

• 🖐️ Clinical exam: Size, shape, mobility.
• 📡 Ultrasound: 1st line in young women; distinguishes solid vs cystic.
• 🖼️ Mammography: Older/high-risk women; detects calcifications.
• 🧪 Biopsy:
  • Needed if atypical imaging or diagnostic doubt.
  • Methods: FNA, core, or excisional biopsy.

🛠️ Management

• 🤝 Reassurance: Most only need follow-up scans.
• 👀 Observation: Monitor for growth/change.
• 🔪 Excision: If >5 cm, fast-growing, or diagnostic uncertainty.
• 🧠 Patient support: Address cancer anxiety and avoid overtreatment.

📚 Case Example

👩‍🦰 Case: A 22-year-old university student presents with a painless lump in her right breast, noticed 3 weeks ago during self-examination. On exam: 2 cm, firm, smooth, highly mobile lump at the upper outer quadrant. No skin changes, no nipple discharge, no axillary nodes. 📡 Ultrasound: Solid, well-defined lesion. ✅ Diagnosis: Likely fibroadenoma. 🛠️ Management: Reassurance + follow-up ultrasound in 6 months. Excision only if it grows, causes anxiety, or exceeds 5 cm.

🌟 Prognosis

• 👍 Excellent outcome: benign.
• ⏳ Many regress, esp. after menopause.
• 🔄 May recur in same/other breast.
• ⚠️ Complex fibroadenomas: slightly ↑ malignancy risk → closer monitoring.

📖 References

• American Cancer Society. Fibroadenoma of the Breast. Link
• NIDDK. Breast Cysts and Fibroadenomas. Link
• Jones TH, et al. Breast Fibroadenoma: Clinical Presentation and Management. J Clin Diagn Res. 2018;12(9):OC15-19.
• Le ML, et al. Management of Fibroadenomas in Young Women. Obstet Gynecol Clin North Am. 2017;44(1):93-108.
• Gilbert A, et al. Breast Masses: Diagnostic and Management Strategies. Radiographics. 2020;40(3):896-918.