Breast conservation with batwing mastopexy for the management of giant juvenile fibroadenoma: A case report of a 12-year-old girl

Abstract

Fibroadenomas are benign breast tumours consisting of epithelial and stromal components. Most of them are about 1 to 2cm in size. It is defined as “giant” when the fibroadenoma is larger than 5cm, weighs more than 500 g or occupies for at least 80% of breast volume. It is usually encountered in patients of less than 20 years of age. Progressively growing mass and its large size cause a suspicion of malignancy. It presents as unilateral macromastia that causes breast asymmetry. Excellent cosmetic results cannot be obtained with simple excision in this situation. We aimed to present a case of a 12-year-old patient with a diagnosis of giant juvenile fibroadenoma. In this case, we performed surgical excision with Batwing mastopexy of the breast to achieve optimal symmetry with contralateral breast.

Keywords

• Batwing
• Fibroadenoma
• mastopexy
• breast
• symmetry

Dev juvenil fibroadenomun yönetiminde batwing mastopeksi yöntemi ile birlikte meme koruyucu cerrahi: 12 yaşinda kız olgu sunumu

Öz

Fibroadenomlar, epitel ve stromal bileşenlerden oluşan iyi huylu meme tümörleridir. Çoğu yaklaşık 1 ila 2 cm boyutlarındadır. Fibroadenom 5 cm'den büyükse, 500 g'dan fazla ağırlığa sahipse veya meme hacminin en az % 80'ini kapladığında "dev" olarak tanımlanır. Genellikle 20 yaş altı hastalarda görülür. Kitlenin progresif olarak büyümesi ve boyutları, malignite şüphesine neden olur. Genellikle meme asimetrisine neden olan tek taraflı makromasti olarak kendini gösterir. Bu durumda basit eksizyon ile mükemmel kozmetik sonuçlar elde edilemeyebilir. Dev juvenil fibroadenom tanısı alan 12 yaşında bir hastayı sunmaktayız. Bu durumda, kontralateral meme ile optimal simetri elde etmek için Batwing mastopeksi tekniği ile cerrahi eksizyon yaptık.

Anahtar Kelimeler

• Batwing
• fibroadenom
• mastopeksi
• meme
• simetri

Kaynakça

1. Kaufman CS, Littrup PJ, Freeman-Gibb LA, Smith JS, Francescatti D, Simmons R et al: Officebased cryoablation of breast fibroadenomas with long-term follow-up. Breast J 2005; 11: 344-350.
2. Kleer CG, Tseng MD, Gutsch DE, Rochford RA, Wu Z, Joynt LK et al. Detection of Epstein-Barr virus in rapidly growing fibroadenomas of the breast in immunosuppressed hosts. Mod Pathol 2002;15:759–764.
3. Oprić S, Oprić D, Gugić D, Granić M. Phyllodes tumors and fibroadenoma common beginning and different ending. Coll Antropol. 2012 Mar;36(1):235-41.
4. Citgez B, Yigit B, Ucak R, Yetkin SG. Giant fibroadenoma of the breast: A case report of a 37-year-old woman during the second trimester of pregnancy. J Surg Med. 2020;4(7):613-615.
5. Makkar N, Singh S, Paul S, Sandhu MS, Kumar A. Bilateral Giant Juvenile Fibroadenoma of Breast. J Clin Diagn Res. 2017 Jun;11(6):ED10-ED12.
6. Matkowski R, Szynglarewicz B, Kasprzak P, Forgacz J, Skalik R, Zietek M et al. Batwing mastopexy as oncoplastic surgical approach to periareolar tumors in upper quadrants. Tumori 2012;98:421-7.
7. Huang IC, Li PC, Ding DC. Recurrent juvenile fibroadenoma of the breast in an adolescent: A case report. Medicine (Baltimore) 2018 May;97(20):e10765.
8. Lee M, Soltanian HT. Breast fibroadenomas in adolescents: current perspectives. Adolesc Health Med Ther. 2015; 6: 159–163.

9. Giannos A, Stavrou S, Gkali C, Chra E, Marinopoulos S, Chalazonitis A et al. A prepubertal giant juvenile fibroadenoma in a 12-year-old girl: Case report and brief literature review. Int J Surg Case Rep. 2017;41:427-430.
10. Nassar A, Visscher DW, Degnim AC, Frank RD, Vierkant RA, Frost M et al. Complex fibroadenoma and breast cancer risk: a Mayo Clinic Benign Breast Disease Cohort Study. Breast Cancer Research & Treatment 2015;153(2):397-405.
11. Izadpanah A, Karunanayake M, Izadpanah A, Sinno H, Gilardino M. An atypical growth of a giant fibroadenoma after trauma. J Pediatr Adolesc Gynecol 2012;25:e115-7.
12. Li J, Humphreys K, Ho PJ, Eriksson M, Darai-Ramqvist E, Lindström LS et al. Family history, reproductive, and lifestyle risk factors for fibroadenoma and breast cancer. JNCI Cancer Spectr. 2018; 2:pky051.
13. Ismail S, Alaidi S, Jouni S, Kassab Y, Al-Shehabi Z. Recurrent giant fibroadenomas with transformation to cystosarcoma phyllodes in a 17-year-old girl: a rare case report from Syria. J Med Case Rep. 2019 Dec 21;13(1):378.
14. Park CA, David LR, Argenta LC. Breast asymmetry: presentation of a giant fibroadenoma. Breast J 2006;12:451-61.
15. Smith GEC, Burrows P. Ultrasound diagnosis of fibroadenoma - is biopsy always necessary? Clin Radiol. 2008 May;63(5):511-5.
16. Łukasiewicz E, Ziemiecka A, Jakubowski W, Vojinovic J, Bogucevska M, Dobruch-Sobczak K. Fine-needle versus core-needle biopsy - which one to choose in preoperative assessment of focal lesions in the breasts? Literature review. J Ultrason 17:267-274, 2017.
17. Pruthi S, Jones K. Nonsurgical management of fibroadenoma and virginal breast hypertrophy. Semin Plast Surg. 2013; 27: 62-66.
18. Littrup PJ, Freeman-Gibb L, Andea A, White M, Amerikia KC, Bouwman D. Cryotherapy for breast fibroadenomas. Radiology. 2005 Jan;234(1):63-72.
19. Bugdaycı O, Kaya H, Arıbal E. Ultrasound Guided Therapeutic Excisional Vacuum Assisted Biopsy in Breast Fibroadenomas. J Breast Health. 2017 Apr; 13(2): 74–76.
20. Kumar HH, Rahman NKF, Ramesh RS, Raghunandan GC. Adding bit of esthetics with science modification of batwing mastopexy for breast conservation in a young patient with giant fibroadenoma breast. J Cancer Res Ther. 2019 Jul-Sep;15(5):1173-1176.
21. Song BS, Kim EK, Seol H, Seo JH, Lee JA, Kim DH et al. Giant juvenile fibroadenoma of the breast: a case report and brief literature review. Ann Pediatr Endocrinol Metab. 2014;19(1):45–48.