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Al Saad S, Al Shenawi H, Al Shenawi N, AlSaffar H, Al Sindi F. Wise Pattern Mammoplasty: The Ideal Option for Giant Fibroadenoma Resection. Cureus 2025; 17:e79677. [PMID: 40161196 PMCID: PMC11951239 DOI: 10.7759/cureus.79677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2025] [Indexed: 04/02/2025] Open
Abstract
Fibroadenoma is a benign tumor of the breast and mainly affects women in early adolescence. Giant fibroadenomas are less common and can be misdiagnosed with breast hypertrophy, pseudo-angiomatous stromal hyperplasia, or phyllodes. Hence, a pre-operative biopsy is mandatory for diagnosis and surgical planning. Wise pattern reduction mammoplasty is ideal for the resection of fibroadenomas. Here, we present a case of a 23-year-old woman who presented with a breast lump diagnosed as giant fibroadenoma. She underwent complete tumor resection using cosmetic wise pattern mammoplasty that is considered one of the best options to preserve the breast shape with negligible deformity.
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Affiliation(s)
- Suhair Al Saad
- Breast Surgery, Dr. Suhair Al Saad Medical Centre, Manama, BHR
| | | | | | | | - Fedaa Al Sindi
- Department of Pathology, Blood Bank and Laboratory Medicine, King Hamad University Hospital, Muharraq, BHR
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Johnson BM, Dewitt J, Balanoff C, Kilgore L, Aripoli A, Collins M. Oncoplastic Breast Reconstruction for Large Pediatric Breast Tumors: A Case Series. Ann Plast Surg 2023; 91:36-41. [PMID: 37450859 DOI: 10.1097/sap.0000000000003576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
ABSTRACT Large breast fibroadenomas in pediatric females may cause discomfort, asymmetry, and psychological stress, and patients may elect for surgical excision. There are no criteria for reconstruction after the excision of these masses, and the research is limited in describing oncoplastic techniques in pediatric fibroadenoma excision. Nononcoplastic techniques, such as mastectomy with implant or flap reconstruction, have been used for pediatric fibroadenoma excision reconstruction. Oncoplastic techniques using Wise pattern or circumareolar incisions have shown to have efficacious outcomes. In addition, pediatric females undergoing breast surgery risk long-term complications such as continued breast asymmetry due to further breast growth, nipple and breast hypoesthesia, and future breastfeeding difficulty. This case series describes the oncoplastic techniques used for large benign mass excision and reconstruction of 3 pediatric females. A Wise pattern technique was used for all 3 patients, and 2 underwent a free-nipple graft. Oncoplastic techniques for pediatric breast mass excision provide satisfactory aesthetic outcomes with minimal surgical morbidity. Further research assessing the long-term effects of pediatric breast mass excision and reconstruction would be beneficial.
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Affiliation(s)
| | | | | | | | - Allison Aripoli
- Radiology, University of Kansas Medical Center, Kansas City, KS
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Zhang Y, Huang J, Zhou L, Leng Y. The largest and heaviest giant juvenile fibroadenoma of the breast in the Chinese population: A case report. Medicine (Baltimore) 2023; 102:e33422. [PMID: 37000060 PMCID: PMC10063306 DOI: 10.1097/md.0000000000033422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/13/2023] [Indexed: 04/01/2023] Open
Abstract
RATIONALE Fibroadenoma is the most common benign tumor of the breast, but giant juvenile fibroadenoma exceeding 20 cm is much rare. This report presents the largest and heaviest giant juvenile fibroadenoma in an 18-year-old Chinese girl. DIAGNOSIS AND INTERVENTIONS An 18-year-old adolescent girl with a 2-year history of a large left breast mass with progressive expansion over 11 months. A 28 × 21 cm soft swelling occupied the entire outer quadrants of the left breast. The huge mass sagged below the belly button, resulting in high asymmetry of the shoulders. Contralateral breast examination results were normal except for hypopigmentary detected on the nipple-areola complex. Under general anesthesia, the lump was completely excised along the outer envelope of the tumor, while reserving excessive resection of the skin. The patient's postoperative recovery was uneventful, and the surgical wound healed well. OUTCOMES A radial incision operation was finally performed to remove the huge mass and to preserve the normal breast tissue and the nipple-areolar complex, not only considering the aesthetics but also preserving the ability to lactate. LESSONS Currently, there is a lack of clear guidelines regarding the diagnostic and treatment modalities for a giant juvenile fibroadenoma. The principle of surgical choice is to balance aesthetics and function preservation.
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Affiliation(s)
- Yuanxin Zhang
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Breast Surgery, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
| | - Junhua Huang
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Breast Surgery, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
| | - Ling Zhou
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Breast Surgery, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
| | - Ying Leng
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Breast Surgery, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
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Wang J, Zhang DD, Cheng JM, Chen HY, Yang RJ. Giant juvenile fibroadenoma in a 14-year old Chinese female: A case report. World J Clin Cases 2023; 11:1808-1813. [PMID: 36969997 PMCID: PMC10037279 DOI: 10.12998/wjcc.v11.i8.1808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/04/2023] [Accepted: 02/16/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND A giant juvenile fibroadenoma (GJF) is a rare, benign breast tumor that affects females < 18 years of age. GJFs are generally suspected based on a palpable mass. GJFs influence breast shape and mammary gland development via the pressure effect from their enormous size.
CASE SUMMARY Herein we report a case involving a 14-year-old Chinese female with a GJF in the left breast. GJF is a rare, benign breast tumor that usually occurs between 9 and 18 years of age and accounts for 0.5%-4.0% of all fibroadenomas. In severe cases, breast deformation may occur. This disease is rarely reported in Chinese people and has a high clinical misdiagnosis rate due to the absence of specific imaging features. On July 25, 2022, a patient with a GJF was admitted to the First Affiliated Hospital of Dali University. The preoperative clinical examination and conventional ultrasound diagnosis needed further clarification. The mass was shown to be an atypical lobulated mass during the operation and confirmed to be a GJF based on pathologic examination.
CONCLUSION GJF is also a rare, benign breast tumor in Chinese women. Evaluation of such masses consists of a physical examination, radiography, ultrasonography, computer tomography, and magnetic resonance imaging. GJFs are confirmed by histopathologic examination. Mastectomy is not selected when the patient benefits from a complete resection of the mass with breast reconstruction and an uneventful recovery.
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Affiliation(s)
- Jing Wang
- Department of Ultrasound, First Affiliated Hospital of Dali University (The People’s Fourth Hospital of Yunnan Province), Dali 671000, Yunnan Province, China
| | - Dai-Di Zhang
- Department of Ultrasound, First Affiliated Hospital of Dali University (The People’s Fourth Hospital of Yunnan Province), Dali 671000, Yunnan Province, China
- Department of Ultrasound, School of Clinical Medicine, Dali University, Dali 671000, Yunnan Province, China
| | - Jia-Mao Cheng
- Department of Anatomy, College of Basic Medicine, Dali University, Dali 671000, Yunnan Province, China
| | - Hai-Yan Chen
- Department of Ultrasound, First Affiliated Hospital of Dali University (The People’s Fourth Hospital of Yunnan Province), Dali 671000, Yunnan Province, China
- Department of Ultrasound, School of Clinical Medicine, Dali University, Dali 671000, Yunnan Province, China
| | - Rong-Jiao Yang
- Department of Ultrasound, First Affiliated Hospital of Dali University (The People’s Fourth Hospital of Yunnan Province), Dali 671000, Yunnan Province, China
- Department of Ultrasound, School of Clinical Medicine, Dali University, Dali 671000, Yunnan Province, China
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Eleftheriades A, Tsarna E, Toutoudaki K, Paschalidou E, Christopoulos N, Georgopoulos I, Mitropoulou G, Christopoulos P. Giant Juvenile Fibroadenoma: Case Report and Review of the Literature. J Clin Med 2023; 12:jcm12051855. [PMID: 36902642 PMCID: PMC10003210 DOI: 10.3390/jcm12051855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023] Open
Abstract
Fibroadenomas are common benign breast tumors. Fibroadenomas that exceed 5 cm in diameter, weigh more than 500 g, or replace more than four-fifths of the breast are characterized as giant. A fibroadenoma diagnosed in patients during childhood or adolescence is characterized as juvenile. An extensive PubMed search of the literature in English up until August 2022 was performed. In addition, a rare case of a gigantic fibroadenoma in an 11-year-old premenarchal girl who was referred to our adolescent gynecology center is presented here. Eighty-seven cases of giant juvenile fibroadenomas have been reported in the literature along with our case. Patients with giant juvenile fibroadenoma presented at a mean age of 13.92 years and usually after menarche. Juvenile fibroadenomas are usually unilateral, occurring either in the right or the left breast; the majority of them are diagnosed when they are already more than 10 cm in size, and they are most frequently treated with total lump excision. Differential diagnosis includes phyllodes tumors and pseudo-angiomatous stromal hyperplasia. Conservative management is feasible, but surgical excision is recommended to patients with suspicious imaging features or when the mass grows rapidly.
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Affiliation(s)
- Anna Eleftheriades
- Postgraduate Programme “Maternal Fetal Medicine”, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Ermioni Tsarna
- Second Department of Obstetrics and Gynecology, “Aretaieion” Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Konstantina Toutoudaki
- Second Department of Obstetrics and Gynecology, “Aretaieion” Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Eleni Paschalidou
- Second Department of Obstetrics and Gynecology, “Aretaieion” Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | | | - Ioannis Georgopoulos
- Department of Pediatric Surgery, “Agia Sofia” Children’s Hospital, 11527 Athens, Greece
| | - Georgia Mitropoulou
- Department of Pathology, “Agia Sofia” Children’s Hospital, 11527 Athens, Greece
| | - Panagiotis Christopoulos
- Second Department of Obstetrics and Gynecology, “Aretaieion” Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Correspondence:
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Kitazawa M, Futamura M, Tokumaru Y, Kohyama K, Nakakami A, Yoshida K. Breast reconstruction using a tissue expander after enucleation of a giant fibroadenoma: A case report. Int J Surg Case Rep 2022; 90:106723. [PMID: 34991047 PMCID: PMC8741496 DOI: 10.1016/j.ijscr.2021.106723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Fibroadenomas are among the most common benign tumors in women. Juvenile giant fibroadenomas account for nearly 0.5% of all fibroadenomas. Due to its size, a giant juvenile fibroadenoma leaves a large defect or deformity after its resection. The optimal surgical management strategy for giant juvenile fibroadenomas remains unclear. Here, we report a case of successful breast reconstruction without residual deformity through gradual deflation of a saline-filled tissue expander after resection of a giant juvenile fibroadenoma. PRESENTATION OF CASE A 14-year-old girl with a growing tumor in her left breast presented to a private clinic. Given that the tumor was 8 cm in size, phyllodes could not be ruled out. Consequently, she was referred to our hospital for further examination and treatment. Core needle biopsy confirmed the tumor to be a fibroadenoma. We resected the tumor and inserted a tissue expander filled with 120 mL of saline, matching the area of the large defect caused by tumor resection. We removed approximately 25 mL of saline every 3 weeks to aid normal mammary tissue enlargement. After completely draining saline from the tissue expander and confirming an acceptable enlargement of the residual mammary gland, we performed an operation to remove the tissue expander. Follow-up revealed that the symmetry and contour of the breast were excellent after the second operation. CONCLUSIONS Our observations suggest that using a tissue expander to enlarge normal mammary tissue may help reconstruct large defects caused by excision of benign tumors.
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Affiliation(s)
- Mai Kitazawa
- Breast Surgery, Department of Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Manabu Futamura
- Breast Surgery, Department of Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Yoshihisa Tokumaru
- Breast Surgery, Department of Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Keishi Kohyama
- Department of Plastic and Reconstructive Surgery, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Akira Nakakami
- Breast Surgery, Department of Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Kazuhiro Yoshida
- Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
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Zeeshan S, Shaikh K, Tariq MU, Vohra LM. Giant Juvenile Fibroadenoma of the breast in a 13-year-old Pakistani girl with excellent cosmetic outcome after subareolar enucleation - A case report. Int J Surg Case Rep 2021; 79:450-454. [PMID: 33757260 PMCID: PMC7851354 DOI: 10.1016/j.ijscr.2021.01.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/23/2021] [Accepted: 01/23/2021] [Indexed: 11/23/2022] Open
Abstract
Diagnosis and management of giant juvenile fibroadenoma can be challenging. Maintaining symmetry after complete excision is tougher in developing breasts. Periareolar approach for subareolar fibroadenomas provides good cosmetic results. Benign tumor to breast size ratio up to 70% provides excellent cosmetic outcome. Introduction Fibroadenoma is the most common benign lesion of breast in young women, characterized by an aberrant proliferation of both epithelial and mesenchymal elements. It is termed giant fibroadenoma when it is larger than 5 cm or weighs more than 500 g with an incidence of 0.5–2% of all fibroadenomas. Presentation of case In this report, we discuss a case of a 13-year-old Pakistani girl who presented with a giant juvenile fibroadenoma in left breast and was treated by a subareolar lump excision through a periareolar incision with excellent cosmetic outcome. To the best of our literature search, this is the first case of giant juvenile fibroadenoma in an adolescent being reported from Pakistan. Discussion Surgical management of giant juvenile fibroadenoma in immature breast is challenging as it may either result in asymmetric defect or damage to developing breast tissue resulting in long term poor outcomes. Surgical decision should be carefully undertaken and reported for future reference in such cases. Conclusion The diagnosis and management of giant juvenile fibroadenoma can be challenging because these tumors clinically and histologically mimic phyllodes tumor due to their rapid growth and large size. Excision through a periareolar approach for fibroadenomas located in subareolar region provides good cosmetic results in these patients with minimal scar visibility.
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Affiliation(s)
- Sana Zeeshan
- Section of Breast Surgery, Department of Surgery, The Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800, Pakistan.
| | - Kulsoom Shaikh
- Department of Surgery, The Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800, Pakistan.
| | - Muhammad Usman Tariq
- Section of Histopathology, Department of Pathology and Laboratory Medicine, The Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800, Pakistan.
| | - Lubna Mushtaque Vohra
- Section of Breast Surgery, Department of Surgery, The Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800, Pakistan.
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Srivastava V, Jha PK, Samhitha CV, Khanna S. Unusual Presentation of Benign Breast Disease in an Adolescent Girl. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02548-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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