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Fibroadenomas are common benign breast tumors. They are found in younger women and will typically present as firm, mobile, painless masses. Initial physical examination coupled with mammography and/or ultrasound can help differentiate it from more suspicious lesions. These masses can grow rapidly which can lead to heightened patient anxiety and discomfort.
A rare subtype of fibroadenoma is termed a "giant juvenile fibroadenoma" and these masses can grow larger than 5cm in diameter. Significant presenting asymmetry of the breasts may occur and subsequent removal of these fibroadenomas can result in concomitant deformity.
Dr. Nahabedian's team describe a novel modification of a "Goldilocks mastectomy" for breast reconstruction of giant fibroadenoma. Their PRS-Global Open article details the pre-operative markings used in this procedure with a schematic outline of the lower pole de-epithelialized flap that is folded superiorly to supplement volume. With this creative approach, the reconstructive surgeon is able to utilize the expanded affected breast skin shape the skin envelope. Concurrently, some of the remaining bulk of the lowermost breast tissue is able to provide volume and projection to the lower pole and retroareolar space. Figure 3 provides an intraoperative view of the lower flap being mobilized and Figure 4 shows a very nice symmetrical outcome at five weeks.
As Dr. Nahabedian notes, the indications for this procedure will vary with the patient's anatomy—both in terms of the affected fibroadenoma side and the contralateral side. However, in the appropriately selected patient, this technique allows for a cost-effective way to reconstruct a large breast defect without engaging the risk of prosthetic devices and without subjecting the patient to a separate donor site surgery.
Partial Breast Reconstruction with Goldilocks Technique After Excision of Giant Fibroadenoma: A Case Report
The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.