Definition of fibroadenoma of the breast
Fibroadenoma of the breast is a mixed tumor of fibrous tissue and glandular epithelium that occurs in the lobules of the breast and is the most common type of benign breast tumor.
Fibroadenoma of the breast can occur in women of any age after puberty and is closely related to the level of estrogen, but is more common in young women aged 18 to 25. The occurrence of this disease is related to endocrine hormone imbalance, such as relative or absolute elevation of estrogen can cause this disease.
The main clinical symptom is a painless breast lump, which is rarely accompanied by breast pain and nipple discharge.
It is generally believed that in a few cases, sarcomatous transformation of the fibrous component may occur, while in very few cases, cancer of the epithelial component may occur.
There are many types of benign tumors that occur in the breast and its adnexal tissues, and there are many types of tumors depending on their tissue origin, site of occurrence, cell type, morphology and arrangement. There are benign tumors of epithelial origin and mixed benign mesenchymal epithelial tumors.
Among breast diseases, fibroadenoma occupies the third place in incidence after cystic hyperplasia and breast cancer; among benign breast tumors, including fibroma and fibroadenoma, it accounts for about 3/4; it is most common in young women aged 20 to 25.
The main symptom is breast lumps, which are usually not accompanied by pain and do not change with menstrual cycle. In some patients, breast fibroids coexist with mastopexy, and premenstrual breast account pain may be present. Mammary fibroids are often solitary, but there are also multiple cases. The lump is round or oval in shape, with a smooth surface, firm texture, clear borders, good mobility, and generally no pressure pain. The mass usually grows slowly and can remain unchanged for several years. It is rarely malignant, but can increase rapidly during pregnancy and lactation, and may change in some patients at this time. If women over 35 years of age, especially postmenopausal women, develop breast lumps with clinical manifestations very similar to fibroids, they must be strictly differentiated from breast cancer.
Fibroadenoma is often a benign breast tumor that occurs in young women, with a peak age of onset at 20-25 years. Estrogen is the stimulating factor for the development of fibroadenoma. Fibroadenomas are mostly round or oval in shape, mostly 0.5-5 cm in diameter, with clear borders, high mobility, slippery sensation on palpation, and generally no pressure pain, no skin adhesions, and no fixation to the pectoral muscle.
Fibroadenoma of the breast is called “nucleus pulposus” in Chinese medicine. In the past, it was also called “breast fetish”, so when you see “breast fetish” in many TCM books, some of them refer to mastopathy and some refer to fibroadenoma of the breast. In order to avoid confusion in naming the two, it has been standardized to the category of “breast nucleus”. According to Chinese medicine, breast nodules are caused by liver qi stagnation or blood stasis and phlegm clotting. According to the book of Surgery, nodules in the breast are “like plums and plums, although they are superficial, they are also the gradual transformation of breast rocks”, recognizing that a few nodules in the breast may become malignant over time.
The most effective treatment for mammary fibroadenoma is surgery. Surgery can remove the adenoma and cure it, but in some cases it can recur at the original site of surgery or regenerate in other parts of the breast. According to traditional Chinese medicine, herbal medicines to relieve depression and blood circulation can adjust the endocrine status of the body and eliminate the lumps in the breast, which can achieve better results in treating adenomas.
Classification of breast fibroids
1.Tissue types of breast fibroids
Fibroadenoma; Adenofibroma; Adenoma
2.Classification of breast fibroids by amount of occurrence
Solitary breast fibroma: occurs in one part of one breast
Multiple breast fibroids: occurring in multiple parts of one or both breasts
3.Special types of breast fibroids.
Giant-shaped breast fibroma: the mass can be very large, or lobulated adenofibroma
Multiple bilateral breast fibroids: the number of fibroids in both breasts is unclear
There are three additional clinical types of mammary fibroids
1. Ordinary fibroadenoma: This type is the most common, with small, slow-growing tumors, usually under 3 cm.
2, youth type fibroadenoma: Most of them occur at the beginning of menstruation, and are less common clinically, characterized by faster growth and larger tumors, which can occupy the whole breast in about 1 year, and the maximum diameter of the lump is about 13cm.
3, huge fibroadenoma: middle-aged women are often seen in pregnancy, lactation, before and after menopause, characterized by large growth, up to 10cm or more, and occasionally sarcoma.
Etiology of mammary fibroadenoma
It is generally believed that the cause of mammary fibroids is related to the high level of estrogen in the body.
The formation of breast fibroids is related to the ovarian function and the sensitivity of the body and local breast tissues to excessive estrogen stimulation.
3. Breast fibroids are mostly seen in women aged 20 to 25 years old during the period of vigorous sexual function. During pregnancy and lactation or pre-menopause, the tumor can grow rapidly due to the large secretion of estrogen.
4.Mammary fibroadenoma is a mixed tumor of fibrous tissue and glandular epithelium in the lobules of breast, which is the most common kind of benign breast tumor and accounts for about 70% of benign breast tumors.
Clinical manifestations of breast fibroadenoma
The main clinical manifestation of breast fibroadenoma is breast lump, and in most cases, breast lump is the only symptom of this disease.
The lumps of breast fibroadenoma are mostly found unintentionally by patients and are usually not accompanied by pain and do not change with the menstrual cycle. In a small number of cases, breast fibroadenoma and mastopathy co-exist, then there may be premenstrual breast swelling and pain.
The lump of breast fibroadenoma is usually found in the outer upper quadrant of the breast. The adenomas are often solitary, but there are also multiple cases. The adenoma is round or oval in shape, and the diameter of 1 to 3 cm is more common, but there are also huge ones.
4.Mammary fibroids have smooth surface, tough texture, clear boundary, no adhesion with skin and surrounding tissues, large mobility, and sliding sensation when touched. The axillary lymph nodes are not enlarged. The adenoma is mostly painless, and there is no tenderness.
5. The size and nature of the tumor usually do not change with the menstrual cycle. The lump usually grows slowly and may remain unchanged for several years, but it may increase rapidly during pregnancy and lactation, and some of them may become sarcoma at this time.
Clinical characteristics of breast fibroids
1. It mostly occurs in adolescent women aged 15-25 years old with high sexual function. Patients have no conscious symptoms, and are often found unintentionally or touched while bathing. Most of them have no pain or tenderness, and occasionally they may have slight tenderness.
2.The most important clinical manifestation of breast fibroadenoma is a single or multiple breast lumps, and in most cases, breast lumps are the only symptom of the disease.
In most cases, breast lumps are the only symptom of the disease. 3.Lumps of breast fibroadenoma mostly occur in one breast, often single, with the preferred site in the outer upper quadrant of the breast, about 75% are single and a few are multiple.
4, breast fibroadenoma is often round or oval, oval, or nodular, lobulated, varying in size, smooth surface, clear boundary, smooth periphery, good mobility, solid and tough or hard texture. It has a sliding sensation when touched, does not adhere to surrounding tissues, has no pain and tenderness, and the surface skin is unchanged.
5.The lump is small at the beginning and grows slowly, and the size of the lump has no effect on the menstrual cycle.
6.No septic ulceration.
7.No axillary lymph node metastasis, not accompanied by nipple overflow.
8. It is generally believed that malignant changes in breast fibroids are rare, but those with repeated recurrences should be highly alert.
Diagnosis of mammary fibroids
1.Most of the patients find lumps in their breasts unintentionally;
2.Most of the masses are located in the upper part of the outer breast, mostly solitary, but a few are multiple, round or oval, with clear borders, smooth surface, toughness, good activity, and no adhesion with epidermis and pectoral muscle.
3.The swelling grows slowly.
Physician examination.
1.The shape of the breast is normal;
2.Most of the palpated masses are painless, some are mildly painful, paroxysmal or occasional or excited during menstruation;
3, the size of the mass varies, some patients have a mass of 10 cm or more; it can be single or multiple;
4, the surface of the palpable mass is smooth, solid and tough, with clear borders, no adhesions with the surrounding tissues, a sliding sensation when touched, and no change in the surface skin;
5.The nipple has clear overflow, but it is rare;
6, axillary lymph nodes are not enlarged.
Auxiliary examinations.
Ultrasonography and mammogram are the main tests. If necessary, fine needle aspiration and aspiration cell examination should be performed to confirm the diagnosis.
Ancillary examinations of breast fibroadenoma
1.Ultrasound examination: weak echogenic reflection, clear boundary, internal echogenic heterogeneity.
2.Mammogram: no shadow or faint round or oval shadows with smooth edges, individual benign calcifications can be seen.
3.Puncture examination if necessary.
Indications for surgical removal of mammary fibroids
The most effective treatment for mammary fibroadenoma is surgery, but it is not necessary to operate as soon as the tumor is found, but the timing and indications for surgery should be strictly controlled.
1. For unmarried women around 20 years old, if the adenoma is not large, about 1cm or even smaller, immediate surgery is not advisable;
2.If the breast fibroid keeps growing slowly to about 1.5cm and the conservative treatment is ineffective, surgery should be considered;
If the adenoma is larger than 2cm when it is first discovered, or if the patient is older than 35 years old, then surgery is recommended as soon as it is discovered;
4.If the breast fibroids are multiple, more than one can be removed at the same time;
4. In addition to the diagnosis of breast fibroids, excision can be done when there are intraductal papillomas, breast cysts, lobular hyperplasia, breast lipomas, parasitic cysts, and breast fibroids are suspected because the nature is not clear.
Contraindications to surgical excision of breast fibroids
Acute infections on the breast and surrounding skin should not be operated for the time being.
If the diagnosis of breast fibroids is not clear, a puncture may be performed for diagnosis and immediate surgery may be withheld.
When there are changes in the criteria for determining the efficacy of breast fibroids, surgery will be withheld.
1.Cure: the lump disappears completely;
2.Improved: the lump is reduced in size;
3, not cured: no change in the lump.
Fibroadenoma of the breast does not necessarily require immediate surgery
Generally speaking, if a fibroadenoma of the breast is found when the patient is young, only around 20 years old, not yet married, and the size of the adenoma is very small, about 1cm or even smaller, then immediate surgery is not recommended. Because.
1, early surgery, the adenoma volume is too small and the activity is too large to be easily found during surgery;
2, unmarried young women, because of the small adenoma surgery, so that the skin of the breast part left a scar, affecting the aesthetic.
3.If the adenoma keeps growing slowly during the observation process, it is advisable to consider surgery to remove it, so that the adenoma will not grow larger and the surgery will be more traumatic and the scar will be more obvious, and there is also a possibility of malignant change if it continues to grow.
4. If the adenoma does not increase significantly in size during the years of observation, it can continue to be observed. If the adenoma is more than 1cm, we should consider elective surgery to remove it until after marriage and before pregnancy. The reason is that during pregnancy and lactation, the estrogen in the body increases significantly, which may stimulate the adenoma to grow rapidly and may even induce sarcomatous changes. Of course, if the adenoma is larger than 2 cm when it is first detected, or if the patient is older than 35 years old, surgery is recommended as soon as it is detected.
Surgical procedure for fibroadenoma of the breast
Incision for breast fibroid removal.
The traditional method of breast fibroid removal is to make a radial incision on the surface of the tumor in order to avoid damaging the ducts, but it will inevitably leave a scar. The traditional radial incision is selectively modified into an areolar incision with satisfactory results.
Surgical methods.
1.Conventional disinfection;
2.Draw a circle of the size of the tumor on the surface of the tumor with melanoma, and then draw a straight line from the midpoint of the circle to the nipple with melanoma;
3.Inject 0.5% lidocaine with a thin needle for local infiltration anesthesia, starting with a semilunar infiltration anesthesia for the areola, and then enter from the areola and infiltrate anesthesia along the straight line of melanoma to the perimeter of the tumor.
4.Cut along the incision drawn, separate the subcutaneous fascia, clamp the lateral fascia of the incision with vascular forceps or Allys, separate the tumor along the surface of the breast tissue with vascular forceps to the tumor site, and then form a tunnel, then use Allys or sutures to pull the tumor to separate and remove the tumor under direct vision.
5. Thoroughly stop the bleeding and intermittent suturing of the breast tissue on the tumor wound for several stitches. After repositioning, the areolar incision is closed with intradermal sutures or interrupted sutures. The breast surface is wrapped with bandages with appropriate pressure for 24-48h.
Disadvantages of surgical treatment
1.Unmarried women around 20 years old, if the adenoma is not large and operated immediately, it is not easy to find during surgery because of the small size of the surgical adenoma and the large mobility;
2, unmarried young girls, because of a very small adenoma and surgery, so that the skin of the breast left a scar, affecting the aesthetic is also a very regrettable thing;
3.Surgical removal is not the solution to the fundamental problem, mainly because although the surgery removes the local tumor, it only treats the symptoms but not the root cause, and the endocrine disorder in the body is not corrected, so it is easy to recur after surgery.
After surgery, some patients may have recurrence in the original surgery site or new adenoma in other parts of the breast, which is very painful for patients.
Management of multiple fibroadenoma of the breast
Multiple fibroadenoma refers to the occurrence of more than 2 fibroadenomas in the breast, which is about 15%. Because multiple fibroadenomas can be fused with each other or scattered on one or both sides, it is difficult to remove them all.
Therefore, for those multiple adenomas that are not too large, they can be observed clinically and continue to be observed as the size of the adenoma decreases; if the mass continues to grow and the size of the adenoma is larger than 2 cm, it can be considered for excision, and if there is a nearby fibroadenoma of about 1 cm, it can also be excised together, while those that are far away and the size of the adenoma is small can be continued to be observed.
Since some fibroadenomas may recur at the original site or new fibroadenomas may appear at other sites after removal of multiple fibroadenomas, it is recommended to take Chinese herbal medicine for a period of time after surgical removal of the adenoma to prevent its recurrence.
Criteria for the efficacy of mammary fibroadenoma
1. The most effective treatment for fibroadenoma of the breast is surgery. In addition, there are also Chinese herbal treatments and hormone therapy and other etiological treatments.
Although surgery is the most effective treatment for breast fibroadenoma, it does not mean that surgery is needed as soon as the adenoma is found, but the timing and indications for surgery should be strictly controlled and cannot be generalized.
For unmarried women, if the adenoma is not large, immediate surgery is not advisable and clinical observation should be the main focus; for young married women, if the adenoma is more than 1cm, surgery is advisable before pregnancy;
4. If a new adenoma appears during pregnancy and lactation, the growth of the mass should be observed first, and those with rapid growth should be operated immediately;
5. If adenomas are found in women over 35 years of age, especially in postmenopausal women, they should be removed immediately by surgery, and intraoperative frozen section examination should be performed;
6.For cases of recurrence in the original place after surgery, we should be alert to its malignant change, each recurrence increases the possibility of malignant change, so the principle of surgery should be slightly expanded to remove some surrounding glands to reduce recurrence.
7.The surgery of breast fibroadenoma needs to pay attention to the function and beauty of the breast while treating the disease. Since most of the patients are young women or not yet married, when the fibroadenoma needs to be removed surgically, a radial incision centered on the nipple should be made in consideration of the patient’s future breastfeeding needs, so as not to damage the milk ducts; the incision should be as small and beautiful as possible, so that the scar after healing is reduced to a minimum.
8. When performing surgery for fibroadenoma, pathological examination should be done routinely. After routine pathological examination and preserving the tissue block for a period of time, it is not only beneficial to the improvement of clinical diagnostic ability, but also to its research and to improve the academic level of the hospital.
Whether fibroadenoma of the breast can become cancerous
Whether breast fibroadenoma can become malignant is a major concern for many patients and also for clinicians, because it is directly related to the prognosis and clinical countermeasures of the disease. It is generally believed that the chance of malignancy in mammary fibroadenoma is very low, with only about 0.2% of cases developing malignancy. Malignancy commonly occurs during pregnancy and lactation, or in older cases with a longer history of disease.
Malignant transformation of mammary fibroadenoma is more common in sarcoma and less common in carcinoma. Most scholars believe that the occurrence of breast cancer is not related to fibroadenoma; some scholars believe that the risk of cancer increases when a patient with breast hyperplasia has fibroadenoma at the same time; some scholars also point out that the occurrence of fibroadenoma in postmenopausal women increases the tendency of cancer.
Although only a small percentage of fibroadenomas are malignant, clinical management should be vigilant, especially for those who are over 35 years old and have a lump of more than 2 cm, in principle, surgical excision and pathological examination should be performed.
Prevention of breast fibroids
The occurrence of mammary fibroids is related to the over-stimulation of estrogen, so they are most often seen in women aged 20 to 25 who are in the prime of sexual function. During pregnancy, lactation or pre-menopause, due to the large amount of estrogen secretion, tumors can grow rapidly; animal experiments also confirmed that large amount of estrogen can induce tumor generation. Therefore, proper control of large secretion of estrogen is beneficial to prevention.
Can fibroadenoma of the breast be cured by medicine?
Breast fibroadenoma is a benign tumor derived from fibrous tissue and glandular epithelium in the lobules of the breast.
Chinese medicine treatment for fibroadenoma of the breast
Chinese medicine calls breast fibroadenoma as breast nucleus. Most of them are caused by internal injury of emotion, liver qi stagnation, or spleen injury due to worries and thoughts, loss of internal production of phlegm; or dysregulation of the flushing and expectation, stagnation of qi, blood stasis and phlegm coagulation, which accumulate in the breast and stomach complex.
Breast fibroids belong to the category of “breast fetish” in Chinese medicine, and their main causes are internal injury of emotions, worry and good feelings, liver qi stagnation, qi stagnation and phlegm coagulation, or worry and thought injury to the spleen, dysfunction of transportation and transformation, and accumulation of phlegm, resulting in the coagulation of qi and blood and phlegm. Modern medicine believes that the occurrence of this disease is related to the imbalance of endocrine hormone levels, caused by the relative or absolute increase of estrogen.
Identification and treatment: liver qi stagnation, small lumps develop slowly, not red, not hot, not painful, can be moved by pushing, may have breast discomfort, chest tightness and sighing. Thin white tongue coating, string pulse
Medicine: compound Xia Ku Cao cream, Xiao Jin Dan, Breast Nodules
Precautions for medication:
1.Small fibroids with clear diagnosis can be treated with medication, and surgical excision is feasible for 2 months if ineffective.
2.Larger or pre-pregnancy fibroids should be surgically removed.
Efficacy criteria: Cured: breast lumps dissipate and breast pain disappears.
Effective: breast lumps shrink by 1/2 and breast pain disappears.
Effective: breast lumps are reduced by less than 1/2, and breast pain is reduced.
Ineffective: the lump does not shrink or grow, and the pain is not relieved.