According to my personal clinical work in Qinhuangdao, I have also had more painful memories: at that time, I had just worked for 1 year, a 26-year-old Ms. Qin*, 4 months postpartum, the left mammary gland at the time of consultation had become a volleyball-sized hard tissue with no elasticity to speak of, the operation was for breast cancer, and soon less than half a year later metastasis of cancer in the right breast appeared, and she passed away 1 year later due to multiple metastasis in the liver and lungs, leaving behind a young daughter. That medical record was written in my own hand and is still fresh in my mind. The patient complained that she had found a small swelling in her left breast during puberty, which was about the size of an almond and could run and move, and that it had increased significantly during pregnancy and was about the size of an egg in the seventh month of pregnancy. After this experience, I agree with Dr. Sun’s philosophy. I hope everyone is healthy and safe, and understands the doctor’s arrangement. Today’s case is a 28-year-old woman with a painless lump in her right breast for 3 years. She is now 19 months postpartum. During pregnancy and breastfeeding, the growth of the lump was unchanged, complaining of a gradual increase in size for only 1 year after breastfeeding. Physical examination, ultrasound suspected malignancy, molybdenum target burr-like mass, axillary lymph node enlargement. Hollow core needle aspiration case: invasive carcinoma of the breast. Sun Ziyuan, Department of Breast and Thyroid Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine For this case, I personally preferred a fibroadenoma that was malignant after the effect of estrogen and progesterone during pregnancy. There is no conclusive evidence, just an inference based on the medical history. Of course, the possibility of a primary breast cancer after breastfeeding or a primary breast cancer prior to pregnancy cannot be ruled out. But, after all, primary breast cancer at age 27 or 25 is very rare. Thus, consider the question, do fibroadenomas in young infertile women need to be removed? When should it be removed? Surgical removal is the only effective treatment for breast fibroadenomas. This is clear. Although many colleagues can easily say that fibroadenomas do not need to be removed, the rate of malignancy is very low or there is no conclusive evidence of malignancy, as in my case above, the so-called malignancy of fibroadenomas is a lot of clinical inference. Inevitably, however, fibroadenomas can also grow progressively larger (instantly and very slowly). In such cases, it may be difficult for the patient to maintain a doctor-like attitude towards a breast lesion, and therefore surgical excision, as opposed to medication or no treatment, may be of value. The increased secretion of estrogen and progesterone during pregnancy stimulates the development of breast tissue, and fibroadenomas may grow rapidly in response to the hormonal effects, increasing the likelihood of overgrowth and uncontrolled growth. The patient’s state of mind may be more stressful during this period, and it is better to deal with it before the pregnancy. Therefore, my advice to young women is to remove any fibroadenomas that are accessible before pregnancy. Regarding the impact on breastfeeding: the surgery will definitely damage the gland, and theoretically the gland in the surgical area is not functional for breastfeeding because the scarring causes the milk ducts to be inaccessible. However, whether it will completely affect breastfeeding should be considered in conjunction with the size, location and number of the fibroadenomas, and also the operator’s operation is very important and should not be too rough. Larger tumors near the nipple area or those that enlarge during pregnancy may likewise affect breastfeeding if not cut, while smaller ones near the periphery of the breast may have little effect on breastfeeding even if operated on. It has been suggested that the induced accumulation of milk in the surgical area may induce mastitis, but clinically mastitis without a history of surgery is the majority. Regarding surgery: trying to protect the gland not to be too rough is the basic principle, for non-lactating women. However, this seems to be contrary to the surgical principles of oncology, which do not advocate simple tumor debulking and require removal of the tumor along with the surrounding tissue. However, in the case of fibroadenomas of the breast, especially the typical ones, I have basically stripped them with the aim of protecting the gland. In addition, Mammotome biopsy is not recommended for young infertile women, it is too traumatic. About the damage to breastfeeding caused by Mammotome biopsy: Breast tumors are located in the glandular layer, which is the anatomical and physiological basis for the physiological function of the breast, i.e., the secretion of milk. the caliber of the biopsy slot of the Mammotome is relatively fixed (23mm×6mm×4.3mm), and the cutting method is stereoscopic, strip by strip. No matter how large the tumor is, the Mammotome will remove an irregular three-dimensional residual cavity, which means that in addition to the tumor, a part of the normal gland will be removed. The damage to the glands will directly affect the local milk secretion, especially for tumors close to the nipple, the Mammotome removal will easily cause multiple large ducts for milk delivery to be cut off, resulting in milk stagnation, poor milk discharge and even the inability to breastfeed the whole breast after delivery. Open surgery simple tumor removal, local residual cavity is the edge is very regular, can maximize the protection of peripheral glands, in order to reduce the damage to the function of lactation. Another clinically difficult to deal with the problem, many young women ultrasonography found breast occupancy, mm level, clinically inaccessible, or even multiple, there is no pregnancy requirements of the patient, self-identification can be regularly observed supplemented by drug therapy, if the patient has a recent pregnancy plan, whether to excise the breast mass? How to balance the weight of disease control, surgical trauma, cosmetic and so on? Personally, I would suggest that observation is the mainstay. After all, the surgical trauma of palpable fibroids is minimal and manageable, whereas inaccessible breast masses often require localization and localized widening of the excision to avoid missed cuts, and the resulting image of breastfeeding may be magnified. Of course, if there is a suspicion of malignancy, an excisional biopsy is necessary. For this segment of the population, the patient’s wishes are particularly important in the choice of treatment options. Therefore, one issue that should not be overlooked is: informing the patient in detail about the impact on breastfeeding and scar formation, and the impact on the physical appearance of the body. Surgery for fibroadenoma is not complicated, but preoperative information is important. Clinical treatment of fibroadenomas varies from doctor to doctor, but there is no need to increase the patient’s psychological burden with alarmist talk. It is the skill and awareness of a breast surgeon to explain the condition to the patient and to relieve his/her psychological stress while treating the patient.