On 24/11/02 9:52 AM, "Automatic digest processor"
<[log in to unmask]> wrote:
> I had a small fibroadnoma that stayed the same size for over a year before I
> became pregnant. During my pregnacy, it grew rapidly and caused plugged milk
> ducts after my baby was born, due to location & size of lump --about 2 inches
> at widest -- in lower left breast. In July the surgeon removed it.
> Pathology report indicated necrosis of the fibroadnoma and also some fat
> necrosis. Just a week ago, I had another sugery in the same location. He
> found even more fat necrosis and a cyst filled with milk around the area of
> fat necrosis. He can't explain why the necrosis is occurring, and yet he
> recommends that I quit breastfeeding soon.
>
> Does this sound like a lactation problem? Can you point me in the right
> direction? Could I just dry up the problem breast? As much as I want to
> continue breast feeding my son, I do not want to do so if it causes damage
> and prevents breastfeeding with future children. HAVE YOU EVER HEARD OF THIS
> SITUATION BEFORE?
I will take a stab at this, however I want to emphasize that my information
in this area results from the reading I do regarding breast disorders
because of my interest in lactation mastitis - and I have no clinical
expertise in non lactational breast disorders. I therefore donšt think the
following info should be forwarded to the mother but that she should be
encouraged to further pursue this problem with her surgeon and seek out more
detailed information about WHY he thinks breastfeeding is a problem in this
situation. He obviously has fears regarding her continuing BF and these
should be shared with the patient (and substantiated) so she can make an
informed decision.
Fibroadenomas are solid, encapsulated, benign, and usually non tender
masses. They result from hypertrophy of a single lobule, containing both
epithelial and connective tissue cells (and not from a single cell), usually
occurring in women between 20-35yrs (rarely after menopause). Management has
traditionally been "expectant" if the age of the woman is under 35-40yrs.
That is - the mass is monitored over time and only if the mass increases
greatly in size (or the woman is concerned) then the mass would be excised.
Which is what seems to have occurred with the mother above.
As Cathy WG pointed out fat necrosis is really only associated with trauma,
from accidents, abuse, or - surgery. So this part of the presentation is
perplexing (because its recurring). Did she have biopsies or other
investigations (mammograms) that may have caused this trauma prior to the
excision? Otherwise perhaps some other source for the trauma should be
sought. I wouldn't think a rapidly growing adenoma would cause surrounding
fat necrosis. The extent of the fat necrosis may be a clue as to its
origins, gross or larger (rather than microscopic) areas could really only
result from external trauma (and these are very, very painful - I've had one
when my toddler elbowed me in the breast!!). Perhaps in her case it may be
something as simple as the baby kicking the breast during feeding.
The relationship of fibroadenomas to cancer is not straight forward, the
literature seems to provide evidence that simple adenomas are not
associated, however complex adenomas, where the the mass is composed of
microscopic elements beyond the basic glandular and surrounding tissue that
make up simple adenomas may (if there is a family history of breast cancer)
increase the risk of future breast cancer development.
It certainly seems that pregnancy may have accelerated the growth of this
fibroadenoma. Literature does hypothesize that fibroadenomas are
responsive to estrogen stimulation - but I have not read anything that might
suggest breastfeeding contributes to the rapid growth of a fibroadenoma (but
my reading is not extensive) - perhaps this is the surgeon's fear (with
foundation or not, I donšt know - perhaps some of the doctors out there may
know more on this) and also I donšt know whether the histology of her
fibroadenoma is "complex" - also leading to a possible increase in his
concerns.
Every patient is entitled to know WHY certain treatments or management are
recommended and again I think your best assistance would be to urge her to
return to her surgeon to seek further details - or if she has no joy in that
- to seek a second opinion.
Regards
Cathy Fetherston CM MSc IBCLC
Perth, Western Australia
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