Fibroadenoma breast

1. A CLINICAL STUDY ON THE RESECTION OF BREAST FIBROADENOMA USING TWO TYPES OF INCISION Scandinavian Journal of Surgery 100: 147–152, 2011 Department of Breast, Nanjing Maternity and Child Health Hospital of Nanjing Medical University, Nanjing , China Department of Breast Surgery, Cancer Hospital/Cancer Institute, Department of Oncology, Fudan University, Shanghai, China Presented by:- Dr.Milind(R2S/F)

2. INTRODUCTION Fibroadenomas (FAs) are most common benign solid tumors composed of stromal and epithelial elements . C onservative treatment of FA is often considered safe and acceptable after adequate triple testing (clinical examination, radiology, and biopsy) In clinical practice, approximately 1/3 of FAs that have undergone long-term periodic monitoring ultimately cause anxiety and discomfort for patients and only surgical resection is curative.

3. Breast fibroadenoma (FA) is traditionally managed by FA excision through an overlying incision (FETOI). FA excision through a periareolar incision (FETPI) has been developed, paying special attention to incision location to preserve cosmesis .

4. Methods The clinical data of 76 patients who underwent FETPI (98 FAs, group A) and 82 patients who underwent FETOI (122 FAs, group B) were retrospectively analyzed in this non-randomized study. Early postoperative complications, nipple sensation loss, and cosmetic results were compared between the two groups . .

5. criteria for surgical treatment Patients older than 35 years of age . Mean change in tumor dimension for a 6-month interval is greater than 20% for all ages . Patients with FAs that are symptomatic Patients younger than 20 years who have a likeli -hood of juvenile FAs . Patients with psychological/nervous disorder caused by long-term regular follow-up. who are unavailable for regular follow-up.

6. FETPI technique indications A n areola diameter greater than 3.5 ~ 5.0 centimeters (cm ), A distance from the outer margin of the mass to the nearest areola’s edge ≤ 5.0 cm. T he largest diameter of clinically diagnosed palpable FAs ≤ 3.0 cm, A ge ≤ 35 years.

7. EXCISIONAL PROCEDURES OF THE FETPI TECHNIQUE The procedure performed under a local anaesthetic or intravenous anaesthesia. C ircumareolar skin incision was made The subcutaneous tissue was dissected off by electro-cautery , pulling the edges of the incision upward with skin hooks. Dissection was continued in the plane between subcutaneous fat and breast tissue, and downward toward the mass. T umour with a 2–3 mm circumferential margin of macroscopically normal tissue is excised The dermis of the skin was approximated using interrupted 4-0 absorbable sutures A running sub- cuticular stitch taken with 4-0 absorbable sutures

8. EVALUATION CRITERIA

9. DISCUSSION ADVANTAGE OF THE PERIAREOLAR INCISION :- Cosmetic results satisfactory.

10. DISADVANTAGES OF FETPI:- The operation time was longer ( by 2 min), and the volume of intraoperative blood loss was larger (by 10 ml) Although statistically significant, both differences, the longer duration and the excess blood loss , are meaningless in clinical practice F lap bruises are more due to excessive traction during surgery, and these may resolve without treatment.

11. NIPPLE SENSATION LOSS:-The only factor found to influence the sensitivity of the nipple in the study was the lateral location of the incision. DISRUPTION OF LACTATION:-The FETPI technique involves extensive undermining and may interrupt milk ducts. To avoid this the dissection plane between subcutane-ous fat and breast tissue should be identified and followed by pulling the edges of the incision up-ward.

12. CONCLUSION If criteria for patient selection are carefully respected, the FETPI procedure can provide both oncological safety and cosmesis . A circumareolar incision should be per-formed when feasible.

13. REFERENCES

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