Excision Of Fibroadenomas Research Articles

Endoscopic Resection of Breast Fibroadenoma

AbstractBackground: Surgical excision was the definitive proce-dure performed for symptomatic benign breast tumors to alleviate anxiety regarding potential for growth or malignancy as well as physical discomfort. However, the efficacy and safety of endoscopic removal of benign breast disease is still a matter of debate.Aim of the Study: The aim of this study is to evaluate feasibility, safety and cosmetic results of endoscopic excision of fibroadenoma of the breast.Patients and Methods: A total of 10 patients underwent endoscopic fibroadenoma excision between June 2016 and August 2017 at General Surgery Department in Tanta Univer-sity Hospital. Patients with recurrent fibroadenoma, multiple swelling or suspicious breast masses were excluded. Cosmetic results, cancer incidence (histopathological surprise), compli-cation rates, and post-operative pain were evaluated.Results: Detailed location of fibroadenoma were in the upper outer quadrant of the breast (n=4, 40%), central supra-areolar lesion (n=3, 30%), and the same presentation for upper inner, lower outer and lower inner lesions (n=1, 10%). Con-version to open technique occurred in two patients (20%). Cosmetic results were excellent in 7 patients (87.5%) and good in one patient (12.5%). Post-operative pain was mild in seven patients (70%) and moderate in three patients (30%). We observed no intra operative bleeding or nerve injury. Subcutaneous emphysema occurred in 3 patients (30%). There was no post-operative seroma, hematoma, wound infection, skin burn nor breast deformity in all cases.Conclusion: Endoscopic resection of breast fibroadenoma is safe and technically simple and is associated with an excellent cosmetic results and a low incidence of complications. Furthermore, it seems to be the optimal procedure, when surgery for benign breast disease is indicated, as endoscopic breast surgery has the advantages of elimination of scars from breast and avoid excess injury of breast tissue.

Aesthetic Unit Boundary Approach to Large Fibroadenoma Resection.

Fibroadenomas are the most common benign breast tumors in adolescents. Surgical excision is indicated when the tumor becomes large or symptomatic. Multiple approaches have been described. However, unsightly scars, excess skin, and breast asymmetry are common challenges after tumor resection. The aims of our study were to describe a concentric circumareolar approach combining the round-block technique and geometric principles in the management of large benign breast tumors. This was a retrospective review of pediatric patients who have undergone excision of large fibroadenoma with concentric circumareolar approach from June 2007 to May 2017. Preoperatively, the excess skin that needed to be resected was marked based on geometric principles. Under general anesthesia, circumareolar deepithelialization of the excess skin and tumor resection were performed. Purse-string suture technique was used to achieve the proper nipple-areola complex size. Satisfactory breast symmetry and minimal scarring were achieved in all 6 patients. One patient developed a small seroma, which resolved spontaneously without intervention. Concentric circumareolar approach can be used to resect large benign breast tumors while concealing the scar along the aesthetic unit boundary of the breast. The cosmetic outcome and recovery were promising. The approach is simple to execute, highly reproducible, and less dependent on intuition.

Is excision biopsy of fibroadenomas based solely on size criteria warranted?

Fibroadenomas (FA) are the most common benign tumor in the female breast. Most are managed conservatively provided there is clinical, radiologic, and pathologic concordance. However, surgical excision is typically recommended for cellular fibroepithelial lesions or those lesions with clinical, radiologic, or pathologic features concerning for phyllodes tumor (PT). Some studies have suggested surgical excision in all FA >30mm to reduce core needle biopsy (CNB) sampling errors. The aim of our study was to evaluate, in the absence of any other concerning clinicopathologic features, whether surgical excision of FA was warranted based on size criteria alone. Cork University Hospital is a large academic center in Southern Ireland. Its breast cancer center provides both a screening and symptomatic service and diagnoses approximately 600 cancers per year. The breast histopathological data base was reviewed for all CNBs from January 1, 2010, to June 30, 2015, with a diagnosis of FA that went on to have excision at our institution. We excluded all cellular fibroepithelial lesions and those cases with co-existent lobular neoplasia, ductal carcinoma insitu, invasive carcinoma, atypical ductal hyperplasia, or lesions which would require excision in their own right. Cases in which the radiologic targeted mass was discordant with a diagnosis of FA were also excluded. Patient demographics and preoperative radiologic size and the radiologic target were recorded in each case. All radiology was reviewed by a breast radiologist prior to inclusion in the study, and there was histologic radiologic concordance with a diagnosis of FA in all cases. A total of 12,109 consecutive radiologically guided CNB were performed January 2010-June 2015; 3438 with a diagnosis of FA were identified of which 290 cases went on to have surgical excision. Of those 290 cases; 98.28% (n=285) were confirmed as FA on excision. The remaining 1.72% (n=5) had atypical features-FA with LCIS (n=1), benign PT (n=3), and invasive ductal carcinoma (n=1). Our study suggests that, excision based solely on size is not warranted in clinical and radiologically concordant cases with a diagnosis of FA on CNB.

Biopsy proven fibroadenomas- how frequent is pathologies other than fibroadenomas post-excision?

Introduction: Breast fibroadenoma (FA) is a common benign tumour diagnosed usually through ‘Triple Assessment’. FA that is large, symptomatic or exhibit interval growth is recommended for excision. Some patients question the need for excision if preoperative assessment concluded FA while others want to be absolutely sure that the ‘FA’ that is not excised and managed conservatively is absolutely a FA. The aim of the present study is to ascertain the magnitude of unexpected post-excision pathology when a biopsy proven FA is excised according to the current UK guideline.Materials and Method: Retrospectively analysis of patients who underwent surgery for FA excision over a 3 year period. Data on patient demographics, ultrasound findings and size at diagnosis, any interval change in size, indication for excision were collected and pathology pre- and post-excision compared.Result: Of the 276 FA excised in 258 patients in 3years, a preoperative diagnosis of FA was confirmed in 251 cases while 25 breast lumps were excised based on the benign features on examination and imaging. The post excision histopathology confirmed the preoperative diagnosis of FA in 264 (95.7%), phyllodes in 8(3%) and 4 (1.3%) other pathologies.Conclusion: 4.3% of FA excised in our specialist unit after Triple Assessment returns pathology other than FA post-excision, mostly benign phyllodes. FAs should be managed conservatively after triple assessment but surgery should be offered if there is still any doubt as there is no absolute guarantee that the presumed FA is actually a FA. For medicolegal reasons and culture of openness, patients should be aware of this possibility especially if FA is managed conservatively.

A comparative study of surgical accesses to breast fibroadenoma

Introduction: A Breast lump is a major health concern amongst women.Increased awareness has resulted in patients seeking early surgical consultation. Surgical resection is traditionally done by Fibroadenoma excision through an overlying incision (FETOI). This technique results in marked scarring. Another approach to Fibroadenoma excision through a periareolar incision (FETPI), which pays special attention to incision location to preserve cosmesis. In this study we assessed the cosmetic superiority and early complications of employing these two incisions in patients with fibroadenoma. Materials and Methods: A prospective non-randomised study of 70 patients who were divided into two groups as per the criteria described in materials and methods section, was carried out in our hospital between April 2015 to September 2017. Examination carried out in detail and diagnosis was established by clinical examination and USG of breasts followed by FNAC of lump. Patients were subjected to FETPIand FETOI Procedures and results were compared. Results: The incidence of early complications such as pain, hematoma and skin flap bruising at post-op day 1, day 2 and day 3 follow-ups did not differ significantly between two groups (P-value>0.05 for all). The distribution of total cosmetic score is significantly better in Group A compared than Group B (P-value<0.001 for all). The distribution of self-assessment score at post-op 1-month, 3-months and 6-months follow-ups is significantly better in Group A compared to Group B. Conclusion: The FETPI technique yields superior cosmetic and self-assessment results with minor incidence of early postoperative complications.

Anesthetic dreaming, anesthesia awareness and patient satisfaction after deep sedation with propofol target controlled infusion: A prospective cohort study of patients undergoing day case breast surgery.

BackgroundAnesthetic dreaming and anesthesia awareness are well distinct phenomena. Although the incidence of intraoperative awareness is more common among patients who reported a dream after surgery, the exact correlation between the two phenomena remains an unsolved rebus. The main purpose of this study was to investigate anesthetic dreaming, anesthesia awareness and psychological consequences eventually occurred under deep sedation. Intraoperative dreaming experiences were correlated with dream features in natural sleep.MethodsFifty-one patients, undergoing surgical excision of fibroadenomas under a Bispectral index-guided deep sedation anesthesia with propofol target controlled infusion, were enrolled into this prospective study. Psychological assessment was performed through the State Trait Anxiety Inventory. A questionnaire was adopted to register dreaming and anesthesia awareness. Data were collected after emergence (t0), 24 hours (t1), 1 month (t2), 6 months (t3).ResultsSix patients (12%) reported anesthetic dreaming at t0 confirming the response at each subsequent evaluation. One patient (2%) confirmed dreaming during anesthesia in all, but denied it at t0. There was a high correlation between the intraoperative dream contents and the features of dreams in natural sleep. No cases of anesthesia awareness were detected. A similar level of satisfaction was observed in dreaming and no-dreaming patients.ConclusionsAnesthetic dreaming does not seem to influence satisfaction of patients undergoing deep sedation with propofol target controlled infusion. A psychological assessment would seem to improve the evaluation of possible psychological consequences in dreamer patient.

Minimally Invasive Breast Fibroadenoma Excision Using an Ultrasound-Guided Vacuum-Assisted Biopsy Device.

Introduction We studied the extent to which an ultrasound-guided vacuum-assisted biopsy device ("hand-held Mammotome") could be used not only as a valuable tool for investigation of suspicious breast lesions, but also therapeutically for the complete removal of breast fibroadenomas. Materials and Methods 132 aspiration biopsies showing fibroadenoma on histology were collected retrospectively. We ascertained whether there were residual findings on breast ultrasound at a median follow-up of approx. 9 months following biopsy. A questionnaire was used to determine the complication rate, patient satisfaction and acceptance of the procedure. Results In this study complete fibroadenomectomy was achieved at aspiration biopsy in 76 % of cases (n = 132). Compared to fibroadenomas larger than 2.51 cm3 (59 %), those smaller than 2.5 cm3 were completely removed more often (87.6 %; p < 0.05). The procedure is associated with very little pain during and after biopsy and minimal haematoma development, both factors supporting a high rate of acceptance among patients. Conclusion Ultrasound-guided vacuum-assisted biopsy is safe and associated with very few complications. Its additional therapeutic potential is dependant on the size of the benign lesion as measured at initial ultrasound.

Efficacy and Safety of Ultrasound Guided Vacuum-Assisted Excision of Fibroadenomas: A Systematic Review

Background: Ultrasound-guided, vacuum-assisted excision [UGVAE] of fibroadenomas is an emerging minimally invasive procedure. UGVAE is being increasingly employed by breast radiologists and surgeons. It has been approved for this use since 2006 by the National Institute for Health and Clinical Excellence in the UK. The aim of this systematic review is to evaluate the efficacy and safety of this procedure based on the up to date available evidence. Methods: A comprehensive literature search of the Cochrane library, Medline, Embase, PubMed, Google scholar, Trip-database, Internet, and the reference lists of relevant articles was performed. We searched for literature with sizeable cases of therapeutic vacuum-assisted excision of fibroadenomas. All prospective studies with more than 20 study participants were screened. The study quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation [GRADE] approach. All were in English. Results: Of the four case series that fulfilled the inclusion criteria there were 516 patients in which 520 procedures were performed. Overall complete excision rate was 89.4%. In two of the studies, this was 100% when the lesions were less than 1.5 cm but reduced to 61% when between 1.5 and 2 cm. Most common significant complication was bleeding with 2 cases of pneumothorax. None of the studies can be regarded as high quality going by GRADE approach. Conclusion: Within the limit of the current published case series, UGVAE appears to be an effective and safe procedure for excision of small fibroadenomas of less than 15 mm in size. A well designed case control study or randomized controlled trials with a sufficient sample size is needed to further assess its safety, effectiveness and more importantly, patients’ satisfaction especially in larger sized fibroadenomas.

Management of Post Operative Mastalgia after Excision of Fibroadenoma with Use of A Vitamin E

Management of Post Operative Mastalgia after Excision of Fibroadenoma with Use of A Vitamin E

When pathological and radiological correlation is achieved, excision of fibroadenoma with lobular neoplasia on core biopsy is not warranted

BackgroundThe diagnosis and management of lobular neoplasia (LN) including lobular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH) remains controversial. Current management options after a core needle biopsy (CNB) with lobular neoplasia (LN) incorporating both ALH and LCIS include excision biopsy or careful clinical and radiologic follow up. MethodsA retrospective analysis of the surgical database at Cork University Hospital was performed to identify all core needle biopsies from January 1st 2010 to 31st December 2013 with a diagnosis of FA who subsequently underwent surgical excision biopsy. All cases with associated LN including ALH and classical LCIS were selected. We excluded cases with coexistent ductal carcinoma in situ (DCIS), invasive carcinoma, LN associated with necrosis, pleomorphic lobular carcinoma in situ (PLCIS) or lesions which would require excision in their own right (papilloma, radial scar, atypical ductal hyperplasia (ADH) or flat epithelial atypia (FEA)). Cases in which the radiologic targeted mass was discordant with a diagnosis of FA were also excluded. Results2878 consecutive CNB with a diagnosis of FA were identified. 25 cases had a diagnosis of concomitant ALH or classical LCIS. Our study cohort consisted of 21 women with a mean age 53 years (age range 41–70 years). The core biopsy diagnosis was of LCIS and FA in 16 cases and ALH and FA in 5 cases. On excision biopsy, a FA was confirmed in all 21 cases. In addition to the FA, residual LCIS was present in 14 cases with residual ALH in 2 cases. One of the twenty-one cases (4.8%) was upgraded to invasive ductal carcinoma on excision.

Transaxillary Subcutaneouscopic Excision of Fibroadenoma of the Breast in Children: The Covert Scar Approach.

Fibroadenoma is a common condition in adolescent girls. Most tumors are excised either through a periareolar approach or the inframammary approach. Both approaches produce visible scars in adolescent girls. We propose a new cosmetic approach to this lesion and report our experience with the transaxillary subcutaneouscopic approach for excision of the fibroadenoma of the breast. The purpose of this case report is to delineate an innovative surgical approach to resection of a breast fibroadenoma that yields an adequate resection without possible damage to the ductal system while optimizing cosmetic results by avoiding scars. We retrospectively reviewed the medical records of four adolescent girls who underwent the above approach for excision of fibroadenoma of the breast. The age range was 14-16 years. There were no complications in all 4 patients. The final result at the 3-month follow-up revealed an esthetically pleasing skin incision that healed well and was hidden by the natural skin fold of the axilla. Transaxillary subcutaneouscopic excision of fibroadenoma of the breast in children is a safe and effective technique and should be considered for excision of benign breast lesions in children.

Intermediate and long-term outcomes of fibroadenoma excision in adolescent and young adult patients.

Fibroadenomas are benign breast masses that often occur in adolescence and young adulthood. Primary management options include observation or surgical excision, but little is known about long-term outcomes after fibroadenoma excision in adolescents. In the present study, we reviewed the medical records of females aged 13-35years who underwent fibroadenoma excision at our institution from 1986 through 2010. Patients were included if they had excision of at least 1 fibroadenoma (confirmed by histopathology) smaller than 5cm in maximal diameter. We collected information pertaining to clinical presentation, management, and outcomes. In addition, an investigator-designed long-term outcome survey was sent to 138 eligible participants to assess patient satisfaction, as well as the recurrence of fibroadenoma, and the need or desire for further surgical intervention. Most patients (126 of 138) underwent 1 operation for fibroadenoma excision. Three women underwent immediate breast reconstruction at fibroadenoma excision. Fifty-seven patients completed the investigator-designed survey (response rate, 41.3%) with a median follow-up time of 13.5 (range, 2.0-26.7) years. Nine of 55 patients (16.4%) reported postoperative breast asymmetry and the desire to pursue reconstructive surgery. Three survey responders reported breast pain. Fourteen of 56 women (25.0%) reported the diagnosis of 1 or more additional fibroadenomas after the initial excision; another 7 reported recurrence of the mass at the site of excision. Most survey participants were satisfied with the aesthetic outcome of their fibroadenoma excision; however, a small proportion believed that they would benefit from reconstructive breast surgery. The recurrence and development of additional fibroadenomas should be addressed by providers during counseling for treatment options and postoperative follow-up.

Intermediate and Long-term Outcomes of Giant Fibroadenoma Excision in Adolescent and Young Adult Patients.

Giant fibroadenomas (5 cm or greater) are benign breast masses that often present in adolescence and require surgical excision. Long-term outcomes, recurrence rates, and the need for additional reconstructive surgery in this population are unknown. Patients aged 11-25 years whose pathology reports indicated the presence of a giant fibroadenoma were eligible for this study. Medical records were reviewed for presentation, treatment, and outcomes. A subset of patients completed an investigator-designed long-term outcome survey to measure additional outcomes and the desire or need for subsequent reconstructive surgery. Forty-six patients with at least one giant fibroadenoma (mean size 7.4 ± 2.8 cm) were identified. Most patients underwent excision with a periaroeolar incision (n = 31), and an enucleation technique (n = 41), and four patients underwent immediate breast reconstruction. Thirty-three patients had complete medical records with a mean follow-up time of 2.2 ± 4.1 years and no complaints of asymmetry, additional breast deformities, or reconstructive surgery procedures documented. In addition, nine patients completed the investigator-designed survey with a mean follow-up time of 10.1 ± 8.7 years (range 1.5-27.0). Three of these patients reported postoperative breast asymmetry and the desire to pursue reconstructive surgery. Aesthetic outcomes of giant fibroadenoma excision may be satisfactory for many patients without immediate reconstruction, but for others, the need for reconstructive surgery may arise during development. Providers should address this potential need prior to discussing treatment options and during postoperative follow-up. Caution should be exercised before recommending immediate reconstruction.

PB.8. Ultrasound-guided excision of fibroadenomas: 9 years' experience in a British breast unit

Fibroadenomas are benign breast tumours made up of glandular and fibrous tissue. Despite their benign pathology, factors such as size, discomfort, altered breast shape and patient choice sometimes lead to excision. Traditionally, open excision biopsy has been the method of choice for fibroadenoma removal but, since 2005, our breast unit has offered patients minimally invasive ultrasound-guided complete fibroadenoma excision using vacuum-assisted core biopsy (VACB). We present an audit of our practice and patient outcomes regarding VACB excision of fibroadenomas.

English

Cosmesis is an important consideration when making breast incisions, especially in young girls. Giant fibroadenomas can produce breast deformity & should be excised. There are several techniques for excision of giant firoadenoma. In our technique, we remove them through cosmetically acceptable circumaerolar incision to maintain the shape & symmetry of breast. We recommend swiss roll technique for the excision of giant fibroadenomas.

Transaxillary Approach With Use of Traction Suture for Excision of Breast Fibroadenoma

Avoiding a scar on the breast is an inherent feminine desire. We devised a new approach for breast fibroadenoma excision:Transaxillary approach with use of traction suture (TATS), in 50 patients with breast fibroadenoma. The swelling was present in the outer breast. The wound healed without noticeable scarring and the original shape of the breast was preserved. All the patients expressed their great satisfaction with the procedure.

A Clinical Study on the Resection of Breast Fibroadenoma Using Two Types of Incision

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. The purpose of this article is to discuss the FETPI technique. 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. The techniques, indications, and special considerations of the FETPI technique were described and identified. The FETPI technique was associated with more early postoperative complications (7/76 vs. 2/82, p = 0.067) and more nipple sensation losses (15/76 vs. 7/82, p = 0.042) than those of the FETOI technique. Cosmetic assessment at 6 months demonstrated statistically more excellent/good results in group A than in group B (62/76 vs. 50/82, p = 0.004). The FETPI technique yields superior cosmetic results with minor postoperative complications.

Benefits of immediate dermoglandular preserving reconstruction following giant fibroadenoma excision in two patients

Giant fibroadenoma is a rare, benign stromal tumor that typically occurs in adolescent women. This rapidly-growing tumor can result in a significant aesthetic and psychosocial morbidity due to gross asymmetry changes in the overlying skin envelope and concerns about malignancy. On initial work-up this lesion must be differentiated from other rare primary breast tumors, including phyllodes tumor, or metastatic disease. Appropriate treatment of giant fibroadenoma requires surgical excision; however, many surgeons are reluctant to perform a concomitant mastopexy or reconstruction at the time of tumor extirpation. This conservative approach results in a loose, ptotic, aesthetically displeasing breast postoperatively. While some degree of skin retraction is expected, patients may have to wait for up to a year to see final results, and further surgical correction may still be required. It is unknown whether these surgeons are not familiar with these techniques or hesitate to increase the amount of scarring on the breast mound of a young female. Using an immediate dermoglandular preserving mastopexy after giant fibroadenoma excision, we have decreased postoperative breast ptosis, removed much of the lax, poor-quality skin and achieved stable, long-term results in two patients. This technique improves the immediate aesthetic outcome, reduces the psychosocial comorbidity associated with waiting for skin retraction and decreases the likelihood of a second surgery.

Evaluation of bcl-2 protein expression in the normal mammary epithelium of premenopausal women treated with raloxifene.

Abstract Abstract #5087 Background: Bcl-2 is one of the most important blockers of cell death and therapeutic strategies to reduce its expression may be useful in breast cancer chemoprevention. The aim of this study was to evaluate the expression of the bcl-2 protein in the normal breast tissue of premenopausal women. Materials and Methods: Thirty ovulatory premenopausal women of 18 to 40 years of age, who had been diagnosed fibroadenoma of the breast participated of this study. This was a randomized, double-blind, placebo controlled study. Patiens were randomized into two groups: Group A (placebo, n=16) and Group B (raloxifene, n=14). The drug was administered in the dose of 60 mg/day for 22 days, beginning on the first day of menstrual cycle. Excision of fibroadenoma was carried out on the 23rd day during which a sample of normal breast tissue was collected for immunohistochemistry. Cells in which cytoplasm was intensely stained in brown by anti-bcl-2 antibody were considered positive for bcl-2. A number of 500 cells on each slide were counted using a light microscope (400x), beginning with the area in which there was the greatest expression of bcl-2. The percentage of stained cells for each case was obtained from the ratio between the number of cells with stained cytoplasm and total of cells multiplied by 100. Student's t test was used to compare the means of percentages of stained cytoplasms in the two groups (p&amp;lt;0.05). Results: There was a significant reduction in the mean percentage of bcl-2-stained cytoplasms in the group that received raloxifene compared to the placebo group, 10.90±2.11 and 19.05±2.36, respectively (p&amp;lt;0.017). Discussion: Our results indicate that raloxifene reduces the anti-apoptotic bcl-2 protein expression in the normal breast tissue of premenopausal women reinforcing the argument for its use in chemoprevention of breast cancer. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5087.

An audit reviewing the management of fibroadenomas with the advent of Mammotome in the breast unit in Bradford

Fibroadenomas are the commonest benign breast tumours. Prior to vacuum-assisted large-volume biopsy, surgical excision was the only therapeutic option available. Our unit introduced Mammotome (Ethicon Endo-Surgery, Cincinnati, OH, USA) in January 2006, with Mammotome excision offered from September 2006 (for lesions 25 mm or less). We reviewed the change in practice with the advent of Mammotome. Patients with histological diagnosis of fibroadenoma throughout 2006 and 2007 were identified. The radiology and histology were reviewed. A total of 355 fibroadenomas were diagnosed in 333 patients: 252 presented symptomatically, 81 were screen-detected. Thirty-five diagnostic Mammotomes were performed (33 had been nondiagnostic on needle-core biopsy, two had radiology/pathology discordance). Definitive diagnosis was consequently made in 34 cases. One patient with nondiagnostic Mammotome had subsequent surgical biopsy of benign fibroadenoma. Seventy patients underwent excision. Fifteen were ultrasound Mammotome excisions; 13 confirmed fibroadenoma and two were phylloides (having surgical cavity excision subsequently). Fifty-five were surgical excisions; 33 were either unsuitable for Mammotome excision or the patient chose surgery; 11 were B2/B3 lesions and pathology recommended surgical excision; and the remaining 11 were before the introduction of Mammotome excision. Mammotome offers patient choice regarding excision of fibroadenomas, and reduces the number of surgical biopsies.