As women, there is nothing quite like the jolt of sheer panic that shoots through your body upon finding a lump in your breast. With statistical estimations of one in eight women in the United States (that's roughly 13 percent) being diagnosed with breast cancer in their lifetimes, it presents a moment of uncertainty so anxiety-inducing that the term ‘fear by paralysis’ comes to mind. The comforting fact is that there are many lumpy presences in breast tissue that indicate noncancerous issues, yet the last thing you want to do is to ignore it.
Being prepared and informed is exactly how you can get through this type of trying moment rationally. I am sharing my own experience with fibroadenoma – and some expert insight from top surgeons – in the hopes that it will help others who find themselves in my position.
My Fibroadenoma Diagnosis
I first noticed a lump in my right breast at 31. It was relatively small, felt moveable and slippery — almost like a little blueberry beneath the surface of my skin — and was not visible from the outside. I remember reaching out panickedly to two of my girlfriends in a group chat, asking, “Have either one of you ever found a lump in your breast!?” One replied that she had not, but the other shared that she had. Her experience was what helped me overcome my fear and book an appointment with my OB-GYN.
At my appointment, my doctor reassured me, stating that the type of lump I presented with was different from the types of emergent masses that typically worry healthcare providers. For her peace of mind and mine, I was referred to a diagnostic mammogram and was diagnosed with a fibroadenoma.
…Fast forward two years. I had just moved back from Paris, France, where I was supposed to be living for two years, but my stay was cut short due to the COVID-19 pandemic. My unwelcome friend was still present and, unfortunately, felt much larger. While still invisible to the naked eye, it had become easy to feel. I worried that if it grew anymore, it would start to create an unsightly bulge.
Back to the doctor I went. I was again referred for a diagnostic mammogram and biopsy. If you ever find yourself in this position and experience fear that you deem to be irrational — in my case, it was because I had already received a benign diagnosis in the past — you are not alone. This is an objectively nerve-wracking process. During the mammogram, your breast is positioned on the machine and photographed. The most uncomfortable part is the squeezing. You are numbed for the needle biopsy, but the noisy (it sounds like a staple gun), handheld machine does leave an extremely small scar. I nervously got through the procedure thanks to an incredibly supportive staff. “Ninety-nine percent of the time, these are absolutely nothing,” the nurse told me comfortingly. “But we just want to make sure, because sometimes — rarely — they surprise us.”
Even though my fibroadenoma is benign, it's large in size. And, because it grew significantly over the course of two years, it was time to get it removed. Before scheduling my surgery, I met and consulted with both of the doctors below — a breast health expert and surgeon and a board certified plastic surgeon — in order to discover my best bet for removal. As a beauty editor, I was also curious as to whether the process would impact the integrity of my breast shape and size post-surgery or if the diagnosis could interfere with getting breast implants. Here is everything I've discovered throughout the process, from my diagnosis to my non-surgical removal.
What Is a Fibroadenoma?
“Fibroadenomas are growths within the breast tissue made up of healthy tissue elements,” says Heather Richardson, MD, a general surgeon and breast health expert at the Bedford Breast Center in Beverly Hills. “They are not associated with breast cancer and don't turn into breast cancers.” As she explains, their presentation is typically described as “slippery” and having “an almost bubbly sensation” when a breast exam is performed. They are round with smooth edges and feel as if they are moving beneath the tissue should you try to secure it. “This is in sharp contrast to most breast cancers, which feel very hard and stuck in place,” Dr. Richardson shares.
Present in approximately 20 to 25 percent of patients (with only little familial significance), those who have been diagnosed with a fibroadenoma are 20 to 25 percent more likely to experience another in the future. Fibroadenomas can appear at any age, though they most often occur in women between the ages of 15 and 35. They are usually diagnosed with ultrasounds. “Mammography is also used to gain more information about the nature of these growths, but ultrasound is the study of choice,” Dr. Richardson notes. Fibroadenomas are identified as smooth round or oval masses of tissue (in my opinion, it looked like a potato on the screen) and tend to be monitored over a period of time. Some growth is normal, and the protocol for monitoring and treatment changes as you age.
In your twenties, the fibroadenoma will typically be monitored by your doctor in six month intervals. But when you get to your forties and fifties (or, in my case, thirties), the likelihood of biopsying the fibroadenoma becomes more likely. Dr. Richardson explains that this is simply to ensure that it is not something malignant presenting atypically. “We should also consider a biopsy of a suspected fibroadenoma if it is enlarging over time or has a change in shape or consistency,” she continues. Furthermore, if there is ever a questionable finding or a family history of cancer (or even a high level of patient anxiety regarding cancer), there should be a conversation about the risks and benefits of proceeding with a biopsy.
Another thing to keep in mind: “Very rarely, if they are very large or have been present for a long time, fibroadenomas can start to grow very quickly and can be reclassified as a type of tumor growth called a phyllodes tumor,” Dr. Richardson says. Again, this is not related to cancer. “They are typically treated with removal and do not require additional treatments,” she adds.
Removing a Fibroadenoma
The removal of your fibroadenoma is largely dependent upon its position. Mine was located close to the surface of the breast. Sometimes doctors will recommend their removal, and sometimes it is patient-initiated because monitoring them with in-office visits can be a nuisance (not to mention, feeling a lump can – as a rule – be unsettling). “Patients may want to remove biopsy-proven fibroadenomas if they are noted on imaging to be changing or growing significantly,” Dr. Richardson says. Additionally, “if the patient feels that they are symptomatic, causing pain, discomfort, a cosmetic change in the breast, or even anxiety,” removal is an option, she notes.
In cases where the patient has multiple fibroadenomas, the doctor will often only remove the more concerning ones and leave the rest in order to preserve the aesthetic appearance of the breast. There are both non-surgical and surgical removal methods, which we outline below:
In the past, Dr. Richardson frequently performed cryoablation, wherein a probe is used to freeze the unwanted, internal breast tissue, destroying the area with the fibroadenoma. Over the course of a few months, the dead or dying tissue temporarily hardens, but then will slowly be flushed away by the body — somewhat akin to CoolSculpting® for the breast. “The downside is that we typically do still want to monitor the areas that have undergone cryoablation in the past, so those patients would not be simplifying their follow-up as they might hope,” she says.
More recently, Dr. Richardson prefers using the BARD vacuum-assisted biopsy tool, which presents patients with a minimally invasive (and more affordable) alternative to surgery. “It offers an excellent alternative for patients who don't want to have surgery or have multiple areas that would create a lot of surgical trauma in the healthy tissue if they were all removed at once,” she says. She recommends the process for small-to-medium fibroadenomas – roughly 2 centimeters or less – that are found deep in the breast.
The treatment is performed awake with numbing agents. You will have the option for a prescribed sedative, like Xanax, but, in that case, you will need someone to drive you to and from the appointment. The entire fibroadenoma removal can be completed in an hour, with the bulk of which is taken up by the numbing. She says to think of the gradual removal process like an electronic Pac-Man that is taking bites from the fibroadenoma. The first couple of days might consist of some bruising and soreness, which can be managed by over-the-counter pain relievers.
Some doctors also use radiofrequency (RF) and ultrasound energy to remove fibroadenomas, however, the critique in the aesthetics industry with these types of devices is that they can — in the hands of the wrong provider — result in the unintended loss of fat. Needless to say, many women would not welcome this side effect.
The surgical excision of a fibroadenoma is, obviously, the more invasive option. It is most appropriate for larger masses. Post-op, the area will no longer need to be monitored, and, in certain cases, surrounding tissue can be sent out for analysis for greater reassurance. The procedure is typically handled by a general surgeon specializing in breast health, though, in instances where the patient is already considering a cosmetic procedure, a plastic surgeon may be involved.
The lump may be able to be removed as part of a larger surgery. “It is rare that I would see a patient simply for a fibroadenoma, however, I will sometimes remove them in conjunction with breast surgery like breast reduction, breast lift, and breast augmentation,” says Robert Cohen, MD, a board certified plastic and reconstructive surgeon in Beverly Hills. “There is obviously a scar after this surgery to remove the fibroadenoma, but often the scar can be hidden along the edge of the areola or in the breast crease.”
The Cost of Removing a Fibroadenoma
Of course, cost is a significant factor to consider when choosing a treatment option. Because the surgery would have been an out-of-network procedure and my insurance deductible has not yet been reached, surgery would have been much more expensive for me (think: over $6,000). That being said, if you are in-network, it might be the better option for you.
For reference, the cost of the BARD procedure was $2,000 out-of-pocket. Insurance has not yet caught onto the ease with which the tool can be used to excise fibroadenomas; thus, they only allow providers to bill for a biopsy. “The reimbursement is the same whether you take a pinch from a core needle that costs the center $20 or if you spend 20 to 60 minutes with a much more expensive device,” Dr. Richardson explains. Thus, not many centers offer the procedure for fibroadenoma removal. If, like in my case, the out-of-pocket cost is still cheaper than the price of what surgery would be, however, it provides a pretty compelling alternative.
Will Fibroadenoma Removal Leave An Indentation?
Depending on the placement and size of the fibroadenoma, its removal may result in an indentation or even a change in the size of the breast. Our experts point out that this is most often the case when there are several fibroadenomas removed or a larger mass. “Quite often, the body will contract the tissue together as it heals and these depressions become less noticeable with time,” Dr. Richardson shares.
But this is not always the case, which is when an aesthetic procedure, like fat grafting, may become appealing. Following your fibroadenoma removal, Dr. Cohen advises waiting to see how the body heals itself before coming in to be assessed for a corrective treatment. “If there is a permanent or noticeable depression, the injection of [harvested fat] in tiny, thread-like injections through fat grafting is an excellent way of building back volume in an uneven area of the breast,” Dr. Richardson confirms. “This is considered safe and performed frequently for patients who have been treated for cancer and have uneven areas of the breast as a result.”
For the uninitiated, fat grafting requires fat be harvested from a donor site (typically from areas like the outer thighs or flanks) via liposuction, purified, and then injected into another area of the body (i.e. the breasts). Naturally slim or athletic patients run the risk of not having enough fat to harvest, while the best case scenario could actually yield enough fat to augment the breasts. “The more experienced the surgeon with aesthetic surgery of the breasts, the better the result will generally be,” Dr. Cohen says.
Though extremely rare, permanent deformity or an alteration to the size of your breast might lead you to consider breast implants. Even so, as one of the top five most popular cosmetic surgeries in the U.S., you might be considering breast augmentation anyway. Dr. Richardson assures us that the presence of a fibroadenoma need not deter you from undergoing any cosmetic breast surgery. “The two decisions should not have major impacts on one another,” Dr. Cohen adds.
But there are some things to consider if you have been diagnosed with a fibroadenoma. For example, if the fibroadenoma is very superficial, the addition of the implant could make it more visible. “In these cases, I would generally do both an augmentation and fibroadenoma removal with possible fat grafting, if needed,” Dr. Cohen explains. He has also had cases where the fibroadenoma was in deeper tissue, and he was able to remove it while placing implants. As an added precaution, Dr. Richardson recommends having your plastic surgeon work with a breast health specialist to ensure that the tissue is removed cleanly, expertly, and aesthetically.
After consulting with both doctors, I decided to go through with the removal of my fibroadenoma. Dr. Cohen helped me decide to wait approximately three months to see if it leaves any sort of indentation, at which point I could consider fat grafting. As I am quite petite, there will only be enough fat to fill any hollowness that is, perhaps, present. In other words, any increase in volume would have to come via implants (and I'm not ready for those just yet).
For my removal itself, I opted for minimally invasive removal using the BARD device with Dr. Richardson. She is one of the few doctors in the entire country that removes fibroadenomas this way, and her practice graciously fit me into an appointment the very next day after my consultation — minimizing the timeframe I would otherwise experience anticipatory anxiety.
The entire appointment lasted a little bit longer than an hour. The bulk of the time was spent numbing my right breast via injections. Because the numbing contains epinephrine (which helps to constrict the blood vessels and minimize bleeding), it actually made me feel physically nervous. I felt my shoulders hunch, my heart pounded, and my voice was shaky. On the inside, though, I felt calmer than I appeared. I opted not to take a prescribed sedative so that I could drive home and keep working, as I'm a Virgo with workaholic tendencies!
As mentioned, the BARD device is used like a little mechanical Pac-Man. Dr. Richardson expertly used an ultrasound to locate and watch the fibroadenoma during the procedure, which is how she found a second — previously unknown — mass that is most likely another fibroadenoma. The larger of the two took 15 minutes to remove, a time frame she assures me is way longer than the norm because of its size. The other literally took five minutes! Both will be sent off to pathology to confirm the diagnosis because it is possible that the larger of the two is a low-grade phyllodes tumor.
Following the procedure, they applied a tan bandage that will remain on for five days over the tiny incision in my areola (it looks like a large pin prick!) and covered the area with gauze. Then, they wrapped me in a bandage that felt reminiscent of a corset. My breast remained numb until just before I went to bed, at which point I took two Tylenol. My outpatient paperwork indicates that I can expect soreness for a few days, but, to be frank, I cooked myself dinner the same evening as my removal and have been easily lifting my small dogs without any trouble since. I will definitely take a day off from any exercise, but am considering a ‘non-vigorous’ elliptical session tomorrow.
As for the breast itself, the appearance has not been altered a single bit. Upon touch, it feels eerily hollow for now — though it's still much better than feeling the mass — and Dr. Richardson assures me that my breast's natural tissue should fill in the space over the next three months. At that point, if I have any hesitations at all, I will be heading straight back to Dr. Cohen's office for fat grafting. And who knows? Maybe by then I'll feel ready for implants, as both surgeons assured me that, if and when I make that decision, my diagnosis of fibroadenomas should absolutely not be a deterrent.
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