fibroadenoma breast

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A CLINICAL STUDY ON THE RESECTION OF BREAST FIBROADENOMA USING TWO TYPES OF INCISION Scandinavian Journal of Surgery 100: 147–152, 2011 Department of Breast, Nanjing Maternity and Child Health Hospital of Nanjing Medical University, Nanjing, China Department of Breast Surgery, Cancer Hospital/Cancer Institute, Department of Oncology, Fudan University, Shanghai, China Presented by:- Dr.Milind(R2S/F)

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Page 1: Fibroadenoma breast

A CLINICAL STUDY ON THE RESECTION OF BREAST FIBROADENOMA USING TWO TYPES OF INCISION

Scandinavian Journal of Surgery 100: 147–152, 2011

Department of Breast, Nanjing Maternity and Child Health Hospital of Nanjing Medical University, Nanjing, ChinaDepartment of Breast Surgery, Cancer Hospital/Cancer Institute, Department of Oncology, Fudan University, Shanghai, China

Presented by:- Dr.Milind(R2S/F)

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INTRODUCTION

• Fibroadenomas (FAs) are most common benign solid tumors composed of stromal and epithelial elements.

• Conservative treatment of FA is often considered safe and acceptable after adequate triple testing (clinical examination, radiology, and biopsy)

• In clinical practice, approximately 1/3 of FAs that have undergone long-term periodic monitoring ultimately cause anxiety and discomfort for patients and only surgical resection is curative.

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• 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.

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Methods

• 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.

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FETPI technique indications

• An areola diameter greater than 3.5 ~ 5.0 centimeters (cm),

• A distance from the outer margin of the mass to the nearest areola’s edge ≤ 5.0 cm.

• The largest diameter of clinically diagnosed palpable FAs ≤ 3.0 cm,

• Age ≤ 35 years.

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EXCISIONAL PROCEDURES OF THE FETPI TECHNIQUE

• The procedure performed under a local anaesthetic or intravenous anaesthesia.

• Circumareolar skin incision was made • The subcutaneous tissue was dissected off by electro-cautery,

pulling the edges of the incision upward with skin hooks. • Dissection was continued in the plane between subcutaneous

fat and breast tissue, and downward toward the mass. • Tumour with a 2–3 mm circumferential margin of

macroscopically normal tissue is excised• The dermis of the skin was approximated using interrupted 4-

0 absorbable sutures• A running sub-cuticular stitch taken with 4-0 absorbable

sutures

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EVALUATION CRITERIA

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DISCUSSION

ADVANTAGE OF THE PERIAREOLAR INCISION :-

Cosmetic results satisfactory.

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• DISADVANTAGES OF FETPI:- The operation time was longer (by 2 min), and

the volume of intraoperative blood loss was larger (by 10 ml)

Although statistically significant, both differences, the longer duration and the excess blood loss, are meaningless in clinical practice Flap bruises are more due to excessive traction

during surgery, and these may resolve without treatment.

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NIPPLE SENSATION LOSS:-The only factor found to influence the sensitivity of the nipple in the study was the lateral location of the incision.

DISRUPTION OF LACTATION:-The FETPI technique involves extensive undermining and may interrupt milk ducts. To avoid this the dissection plane between subcutane-ous fat and breast tissue should be identified and

followed by pulling the edges of the incision up-ward.

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CONCLUSION

• If criteria for patient selection are carefully respected, the FETPI procedure can provide both oncological safety and cosmesis.

• A circumareolar incision should be per-formed when feasible.

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REFERENCES

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Thank you