Tratamientos de fibroadenoma de mama

Las opciones de tratamiento del fibroadenoma de mama pueden variar dependiendo de muchos factores, como si el fibroadenoma es simple o complejo. Las opciones pueden incluir la espera vigilante (observación del fibroadenoma a lo largo del tiempo), una lumpectomía para extirpar el fibroadenoma, técnicas de ablación que van desde la terapia con láser, la crioablación y la ablación por radiofrecuencia, y más. Conozca estas diferentes opciones y cómo su fibroadenoma puede influir en su riesgo futuro de cáncer de mama.

Definición

Los fibroadenomas mamarios son tumores mamarios no cancerosos que se componen de estroma (tejido conectivo fibroso que soporta la glándula mamaria) y adenosis (lóbulos que han desarrollado hiperplasia).

Los fibroadenomas se pueden palpar durante el autoexamen mensual de los senos  y aparecerán en mamografías y ecografías. Las mujeres de 20 o 30 años tienen más probabilidades de desarrollar un fibroadenoma de mama, que puede aumentar de tamaño durante el embarazo o la lactancia (lactancia).

Los tipos

Hay dos tipos diferentes de fibroadenomas y es importante distinguirlos al elegir las mejores opciones de tratamiento. Las personas a menudo preguntan si tener un fibroadenoma aumenta el riesgo de desarrollar cáncer de mama. Con los tipos más comunes, la respuesta es no. Los tipos de fibroadenomas incluyen:

  • Simple. Most fibroadenomas are the simple types—there’s usually just one of them in your breast, with a definite border and very uniform cells. A simple fibroadenoma does not raise your risk for breast cancer.
  • Complex. Complex fibroadenomas are less common, and while they may have a definite border, it’s what is inside this kind of fibroadenoma that makes it different. A complex fibroadenoma will not look organized and uniform like a simple fibroadenoma. Even though complex fibroadenomas don’t become cancerous, they may contain a collection of small cystscalcifications, enlarged breast lobules, papillomas and different kinds of hyperplasia. When atypical hyperplasia occurs, however, it can raise your risk of developing breast cancer.

Diagnosis

A breast fibroadenoma will usually feel smooth, firm and rubbery. It may move within your breast tissue when you’re doing your breast self-exam, and it is not likely to feel painful or tender. Most of these benign lumps are between one and three centimeters (½ to 1 ½ inches), but some may grow as large as five centimeters (around 2 ½ inches).

Your radiologist will be able to see a fibroadenoma on your screening mammogram, and an ultrasound will help distinguish it from a fluid-filled cyst. But the most definite way to get a diagnosis of fibroadenoma is with a breast biopsy.

Cautions

It’s important to point out a few cautions with fibroadenomas. These benign breast lumps are most common in women under the age of 35. In women older than age 35, a definitive diagnosis is more important. A breast biopsy is one way to do this, though a breast biopsy only samples one part of a lump. We now know that many breast lesions, both benign and cancerous are heterogeneous. This means that the cells in one part of the tumor may be different than those in another part of the tumor. There have been cases in which a breast biopsy has revealed a fibroadenoma, but after removal, when the entire lesion is evaluated by a pathologist, cancer has been present as well.

Treatment Options

If your doctor has confirmed a diagnosis of a fibroadenoma, there are several different treatment options available. These span the spectrum from simply observing the fibroadenoma, to a lumpectomy. There are many factors that may affect your choice of treatment. One is whether you have a simple or a complex fibroadenoma. Your symptoms are important as well. Are you having discomfort? Or, instead, are you having emotional discomfort due to wondering if you’re possibly missing something. What you are feeling emotionally is as important as what you are feeling physically for the most part. Make sure that your doctor understands what you are experiencing so that you are on the same page. Don’t say all is well an go home and fret. Treatment options include:

Watch and Wait

  • Watch and wait is one approach. Since fibroadenomas are not always troublesome and sometimes shrink on their own, just keeping an eye on their progress is the least invasive way to handle them.

Lumpectomy

  • Lumpectomy, or surgical removal of a fibroadenoma, can be done if you’re worried about keeping it in your breast. Depending on the relative size of this lump and your breast, a lumpectomy may cause a change your breast’s size or shape. New fibroadenomas may grow in the neighborhood of the first lump, so you should know that surgery is not a guarantee that you’ll never have another fibroadenoma. On the other hand, your fibroadenoma can be carefully examined by the pathology lab to make sure the diagnosis was correct (a biopsy isn’t 100 percent effective in making a diagnosis as it only samples one part of the lump) and breast cancer can be ruled out.

Laser Ablation

  • Laser ablation is a non-surgical way to get rid of a fibroadenoma. In your surgeon’s office, an ultrasound-guided laser device is used to destroy the fibroadenoma, leaving behind only a tiny scar, no sutures, and no change in breast shape. There’s no general anesthesia needed and it can usually be done as a same-day surgery procedure.

Cryoablation

  • Cryoablation is a fast, efficient way to freeze a fibroadenoma. In one office visit, cryoablation simply freezes the lump so that healthy tissue can take over. This procedure takes less than 30 minutes and results in a tiny scar.

Radiofrequency Ablation (RFA)

  • Radiofrequency ablation (RFA) removal of fibroadenomas is another way to take an unwanted lump out of your breast without resorting to a lumpectomy. Using local anesthesia and ultrasound guidance, a six to eight-millimeter cut is made above the fibroadenoma. Through this cut, a surgical wand is inserted and then tipped by a knife that is heated by radiofrequency current. This helps cut through the breast tissue without causing much bleeding. Once it reaches the target, small wires and robotic arms capture the fibroadenoma and extract it.

Mammotome

  • Mammotome breast biopsy systems can now be used as a fairly non-invasive way to remove fibroadenomas. In less than an hour, and under local anesthesia, a six-millimeter (1/4 inch) cut is made over the fibroadenoma. Then with ultrasound guidance, a Mammotome probe is threaded into the lump, which vacuums out sections of the tissue. Recovery is quick and your scar will be quite small.

High-Frequency Focused Ultrasound (HFU)

  • High-frequency focused ultrasound (HFU) is a relatively new treatment that has been used for fibroadenomas, and sometimes, even for breast cancer. HFU can apparently cause the selective destruction of deep tissues without damaging surrounding healthy tissue.

Complementary and Alternative Medicine

  • Homeopathic treatments have also used to prevent or treat breast fibroadenomas, though there are few controlled studies looking at these procedures. Herbal tonics, teas, ointments, or homeopathic pills have been used in traditional cultures for fibroadenomas. Hot compresses of water, castor oil, or ginger tea have been tried as well, for the relief of breast tenderness which may or may not be due to a fibroadenoma. It’s important to note that without a biopsy, and possibly removal of the fibroadenoma, there is always a chance that a breast cancer could be missed, and therefore treatment delayed.