TREATMENT

First, education the patient about the illness, risk factor, treatment, and prognosis.
While some fibroadenomas are excised because they cause breast pain or distortion, either the
clinician or the patient is concerned that it may be cancer or another aggressive lesion
(Hubbard et al., 2014).
So, if clinical and US (Ultrasonography)
findings are benign, all that is needed is reassurence from the patient and/or
caregiver. It is suggested that conservative follow-up exams with US. US follow-
up is generally conducted at 6-month intervals in the first year and a US. follow-
up at the end of the second year after 12 months (Lee et al., 2018). Many doctors recommend
removing fibroadenomas, especially if they keep growing or the patient still pain (Hubbard et
al., 2014). Surgical excision is recommended for masses with :
1. The lesion must be sonographically visible
2. The diagnosis of fibroadenoma must be confirmed histologically.
3. Lesions should be that are bigger than 5 cm or grow quickly in
US characteristics (Lee et al., 2018; Orr and Kelley, 2016).

Endoscopy-assisted breast surgery technique (EABS)

Endoscopic video monitors were installed on both sides of the patient's head (Olympus
Optical Co., Tokyo, Japan) and watched by two surgeons. In all procedures, an ended, ridged
endoscope with a diameter of 3 mm with a viewing angle of 0 ° was used (Lai et al.,2017).
A tumescent solution (lactated 100 ml Ringer solution comprising 5 ml sodium bicarbo
nate, 20 ml 1% lidocaine, and 0.5 ml epinephrine (1:1000)) was subcutaneously injected into
the entire breast to minimize bleeding (Lai et al.,2017).
Periareolar incision of the skin (one third or semiperiareolar) or axillary incision (when
the tumor was close the axilla) was performed.An optical bladeless trocar (Johnson & Johnso
n, Tokyo, Japan) was used to create a 3-
5 mm thick skin flap under endoscopic instruction or an Xcel trocar blindly.The wound edge
protector was put to avoid wound maceration, which is a waterproof patch fixed with 4–
0 nylon sutures (Gonzalez and Pimpalwar, 2016).

.
 The septa was originally dissected under direct vision between the skin flap and parenc
hyma and then used under endoscopic instruction with bipolar scissors (Powers Star, Johnson
& Johnson KK).
Under endoscopic guidance, the subcutaneous flap was dissected beyond the blue hue ti
ssue to create work space. The breast parenchyma was resected with an electrocoagulator and
a light retractor under direct vision after sufficient space was created. (Gonzalez and
Pimpalwar, 2016).
During the periareolar wound, tumor samples were removed. After resection of all tum
ors, the organ was rebuilt using 3-
0 absorbable sutures to undermine, advance and perform a layered closure of the adjacent gla
ndular breast tissue. The wound protector was removed and 3–0 polysorb and 4–
0 monocryl sutures were used to close the wound (Lai et al.,2017).
The adventeges
A circumareolar incision leaving the least noticeable scar is a popular approach to benig
n breast lesion management The cosmetic outcome is beneficial, and generally the tumor can
be resected properly (Lai et al.,2014)
An incision above the lesion can lead to suboptimal esthetic results and is one of the ma
in reasons why patients are often unwilling to receive breast tumor surgical excision even wh
en the illness is symptomatic (Lai et al.,2014).
The main limitation of endoscopy
assisted breast surgery is that general anesthesia and hospitalization are needed

(Lai et al., 2017)

(Li et al., 2014)

(Gonzalez and Pimpalwar, 2016)

 (Gonzalez and Pimpalwar, 2016)

Reference

Lee EJ, Chang YW, Oh JH, Hwang J, Hong SS, Kim HJ. 2018. Breast Lesions in Children
and Adolescents: Diagnosis and Management. Korean J Radiol, 19(5): 978-91.
Hubbard JL, Cagle K, Davis JW, Kaups KL, Kodama M. 2014. Criteria for Excision of
Suspected Fibroadenomas of the Breast, The American Journal of Surgery, 1-16.
Lai HW, Lin HY, Chen SL, Chen ST, Chen DR and Kuo SK. 2017. Endoscopy-assisted
surgery for the management of benign breast tumors: technique, learning curve, and
patientreported outcome from preliminary 323 procedures. World Journal of
Surgical Oncology, 15 (19): 2-9.
Orr B and Kelley JL. 2016 Benign breast diseases: Evaluation and management. Clin Obstet
Gynecol, 59 (4): 710-726.
Lai HW, Kuo YL, Su CC, Chen CJ, Kuo SJ, Chen ST, Chen DR. 2014. Round block
technique is a useful oncoplastic procedure for multicentric fibroadenomas, the
surgeon,1-5.
Gonzalez M, and Pimpalwar A. 2016. Transaxillary Subcutaneouscopic Excision of
Fibroadenoma of the Breast in Children: The Covert Scar Approach. Journal Of
Laparoendoscopic & Advanced Surgical Techniques, 26 (2) : 157-160.