At birth the breasts consist of small buds comprising primitive ducts, milk |
glands and fibrous tissue. At puberty under the influence of the hormones
produced by the ovaries the breast buds enlarge and flower like the branches
of a tree. It is thought that fibroadenoma are breast buds that never fully
develop during puberty and remain stuck down, forming a hard lump.
The name fibroadenoma comes from "fibro" - fibrous tissue and "adenoma" - glandular tissue. Because fibroadenoma do contain breast tissue elements they can get very slowly bigger with time. Rapid growth such as doubling in size in a few months is not a feature of fibroadenoma. During pregnancy and breast feeding fibroadenoma respond to the hormones of pregnancy and breastfeeding. They are fooled into thinking they too can produce milk! Once breast feeding is completed the fibroadenoma returns to its former size. Fibroadenoma are also under the influence of the menstrual cycle and just as you can experience premenstrual tenderness and swelling, fibroadenoma may also appear more prominent and tender prior to a period.
It is possible to have more than one fibroadenoma in the same breast and also to find them in the other breast. They may not always be apparent at the same time because of their size and location in the breast. Breast ultrasound may not be able to detect all fibroadenoma due to density factors. Fibroadenoma may look very similar to the fatty-fibrous tissue on ultrasound and may not show up until they get to be a little bigger and denser. Fibroadenoma may also not show up on mammograms due to the density of the surrounding tissue.
Fibroadenoma have classical features of being firm, smooth, oval or round, mobile solid lumps. They have also been called "breast mouses" because small, mobile fibroadenoma may dart around and be very difficult to find at times ! They are commonly found in women between the age of 18 and 35 years and would account for practically all solid lumps in women under the age of 25 years. Fine needle aspirate (a procedure where cells are suctioned from the lump) of fibroadenoma can be extremely helpful in diagnosis.
Fibroadenoma by themselves are not precancerous. Pathologists have further classified fibroadenoma into complex fibroadenoma and non-complex fibroadenoma. Complex fibroadenoma have some benign differences internally when compared under the microscope with non-complex fibroadenoma. These differences may include calcifications and cystic changes. The Pathologist also independently looks at the tissue the fibroadenoma sits in. The Pathologist may comment that the tissue surrounding the fibroadenoma is fibrocystic tissue and go into further detail regarding the activity of this tissue. To understand these comments please refer to the information sheet on this.
Essentially each solid lump needs to be assessed on its own merits and a management plan formulated. The decision for conservative management (non surgical) versus surgical removal needs toLink to St Marks Breast Centre Online