Breast-conserving surgery in giant juvenile fibroadenoma: a case report

Abstract

: Giant juvenile fibroadenoma (GJF) represents 0.5% of fibroadenomas and the usual age range of occurrence is 10 to 18. GJF definition describes a benign tumor that measures more than 5 cm, weighs more than 500 grams or occupies more than 80% of the mammary gland. In this report, we present the case of a 14-year-old patient’s GJF with six months of evolution. The examination proved skin and the Nipple-Areola Complex (NAC) involve, resulting in the identification of a smooth, firm and mobile tumor of 20 cm with negative local lymph nodes. The diagnosis used Mammography (MG), Ultrasound (US), and Magnetic Resonance Imaging (MRI). In addition, Breast Conservative Surgery (BCS) required making an incision in the breast groove, resulting in good aesthetic results. To the best of our knowledge, there is no standard surgical approach. In practice, the treatment options for BCS are enucleation, Wide Local Excision (WLE) and oncoplastic techniques, and Simple Mastectomy (SM) considering or excluding reconstruction. This case challenged medicine itself since human skin gained elasticity after six months, it did not reach full breast development, and hormonal action exposition was present all time, which can generate recurrences, for instance, pregnancy or psychological factors. Whilst GJF is a pathology that requires Therapeutic Board (TB) criteria for adequate BCS, it needs a multidisciplinary team including a Gynecology Oncologist specialist, Plastic and Reconstructive Surgery (PRS) specialist, and a psychologist, where the aesthetic result of the patient should always be priority. This case shows the importance of making adequate differential diagnosis (DD) and respecting oncological principles. In a year of follow-up, skin retraction improved due to normal breast development suggesting effectiveness of the technique.