Fibroadenoma Surgery in Ankara, Turkey

Fibroadenoma surgery is the surgical removal of benign tumors detected in the breast. Fibroadenomas, which are usually seen as painless and movable lumps, are removed with operative intervention if they grow in size or take on a suspicious appearance.

The surgical procedure is performed under local or general anesthesia and is most often carried out with minimally invasive techniques. After the surgery, efforts are made to preserve the aesthetic structure of the breast tissue, and patients can return to their daily lives in a short time.

Removing a fibroadenoma does not reduce the risk of breast cancer, but it is important for ensuring diagnostic certainty. After the operation, pathological examination confirms that the mass is benign and possible risks are evaluated.

In the postoperative period, wound care, infection control, and monitoring changes in the breast tissue are important. Patients are advised to continue regular check-ups and to consult a doctor in the event of any new lump.

You can contact Prof. Dr. Ebru Soy, one of the doctors performing Fibroadenoma Surgery in Ankara, to get information about Fibroadenoma Surgery prices, the process, and the hospital where Fibroadenoma Surgery is performed.

What Is a Fibroadenoma?

A fibroadenoma is a benign tumor that forms in the breast, usually seen in young women. It is felt as a round, well-circumscribed, mobile, and painless lump. Its size may change with hormonal changes. It does not carry a risk of cancer, but follow-up is recommended. Diagnosis is made with ultrasound, mammography, and, if necessary, biopsy. In large or suspicious cases, it can be surgically removed.

When a fibroadenoma is found, is surgery always necessary?

No, it is not. When a needle biopsy (core biopsy) is performed on a mass and the pathology result is definitively confirmed as a “simple fibroadenoma,” the mere presence of this mass alone is not, by itself, a reason for surgical removal.

Current medical practice offers two main options for simple fibroadenomas confirmed by biopsy: observational follow-up or therapeutic intervention (i.e., removal or ablation of the mass). The decision is made jointly by considering the size of the mass, growth rate, the patient’s age, family history, and most importantly the patient’s own preferences and level of concern.

When a decision for “follow-up” is made, what does this mean for the fibroadenoma?

A follow-up decision means monitoring the mass at certain intervals instead of removing it immediately. This is generally preferred when it is certain that the mass is benign. This is because some of these masses may shrink on their own over time (may regress) or remain the same size for years.

Reputable institutions such as the American College of Radiology (ACR) present short-term follow-up as a reasonable option for masses that show “probably benign” features on ultrasound (i.e., compatible with fibroadenoma), instead of immediate biopsy or surgery. This follow-up is usually done as an ultrasound check every six months for two years. The aim is to observe whether there is a change in the size or shape (morphology) of the mass.

If it is benign, why do some patients prefer removal instead of follow-up?

Although the follow-up method is medically safe, it may not be suitable for every patient. Knowing that there is a palpable mass in the breast can cause significant anxiety in some patients. Concerns such as “What if it grows?” or “What if it was misdiagnosed?” can reduce the patient’s quality of life.

In addition, a follow-up process that lasts for many years can bring its own difficulties. If a change is noticed in the mass years later, this can lead to diagnostic confusion again and require a repeat biopsy.

For these reasons, especially in young patients, removing a palpable mass with a simple surgical procedure offers diagnostic certainty, provides psychological relief, and reduces the future follow-up burden. In light of all this information, the patient’s request for removal of the mass is a valid reason for intervention, even if it is not a medical necessity.

When is a decision made for “intervention” instead of “follow-up” for a fibroadenoma?

The decision for intervention, meaning removal or ablation of the mass, is usually based on certain “triggers.” The breast surgeon evaluates each patient according to their individual situation.

The main reasons leading to this decision are:

• The size of the mass
• Growth rate
• Biopsy (pathology) result
• The patient’s preferences and complaints

How important is the size of the mass in the decision for fibroadenoma surgery?

Size is one of the most fundamental factors in the decision to intervene. In general, when the size of a fibroadenoma exceeds 2 cm, surgical removal comes into consideration. Although some older guidelines state this limit as 2.5 cm, masses over 2 cm are both easier to feel and begin to reduce the success of some minimally invasive methods.

If the mass is over 5 cm, it is called a “giant fibroadenoma.” This is seen in approximately 0.5% to 2% of all fibroadenomas. Due to their size, giant fibroadenomas can cause visible asymmetry and deformity in the breast. These masses must be surgically removed.

Why is it important if the fibroadenoma diagnosis shows “rapid growth”?

This is perhaps one of the most important alarm bells. Rapid growth is generally defined as a volume increase of more than 15% per month.

The importance of rapid growth is this: Sometimes there is another type of mass called a “Phyllodes Tumor” that can look very similar to a fibroadenoma but can behave differently. Phyllodes tumors can be benign, borderline, or malignant. Imaging methods (ultrasound or mammography) may not always definitively distinguish between these two (fibroadenoma and phyllodes).

If a mass, especially one that has even been diagnosed as a “fibroadenoma” by biopsy, grows rapidly during follow-up, this is a strong warning to rule out the possibility of a “Phyllodes Tumor.” In this case, it becomes mandatory to surgically remove the entire mass and examine it pathologically.

Which biopsy (pathology) results make fibroadenoma surgery mandatory?

Some findings from a needle biopsy (core biopsy) can make surgery mandatory regardless of the size or growth rate of the mass.

These situations are:

• Detection of “atypia” in the report
• Suspicious cells such as “Atypical Hyperplasia”
• Diagnostic uncertainty (suspicion of phyllodes)
• The description “fibroepithelial lesion”
• Discordance between imaging and pathology (discordance)
• Other suspicious findings such as papillary lesions

Why are these findings important? For example, the presence of “atypia” may be a sign of a more serious condition (a focus of cancer) within the mass or may carry a risk of “upgrade” to cancer. “Discordance” may mean that the needle sampled a benign fibroadenoma next to the actual suspicious area rather than the suspicious area itself. In such cases, the mass must be surgically removed for a definitive diagnosis.

Are the patient’s complaints or preferences a sufficient reason for surgery?

Yes. Even if there is no medical or pathological necessity, the patient’s requests may be a sufficient reason for intervention.

These reasons are:

• Pain or tenderness related to the mass
• Cosmetic concerns (being noticeable from the outside)
• Deformity it causes in the breast
• The patient’s intense anxiety

Even if the surgeon knows that the mass is benign, they should respect the patient’s informed preference in this matter and present treatment options.

What is classic surgical excision (lumpectomy), and when is it considered the “gold standard”?

Surgical excision is the procedure, also known among the public as “lumpectomy” or “open surgery,” in which the mass is physically removed completely using a scalpel (bistoury).

In masses that carry pathological risk (atypia, suspicion of phyllodes, etc.) or are very large (usually >4-5 cm), and in cases where minimally invasive methods are insufficient, this is the “gold standard” treatment method. Depending on the size and location of the mass, the procedure can be performed under local anesthesia and sedation or under general anesthesia.

How are non-palpable fibroadenomas found during surgery?

Sometimes fibroadenomas are found incidentally, especially during screening mammography or ultrasound, and are not felt on manual examination by the patient or physician (“non-palpable”). In this case, the surgeon needs a marking method to know what to remove during surgery.

The main methods used today include:

• Wire localization (Guidewire Localization – WGL)
• Magnetic seed localization (Magseed)
• Use of ultrasound during surgery (IUGE)

What is the “wire localization” (WGL) method, and what are its challenges?

This is the traditional method. On the same day as the surgery, immediately before the operation, the patient goes to the radiology department. Under ultrasound or mammography guidance, the radiologist places a thin wire into the mass. One end of the wire remains inside the mass, and the other end remains outside the breast skin.

This method has some important limitations:

• The necessity of same-day scheduling for both radiology and the operating room
• Low patient comfort (waiting with a wire protruding outside)
• Risk of wire displacement (migration)
• Potential for the surgeon to miss the target

How do modern fibroadenoma localization methods like magnetic seed (Magseed) work?

There are much more modern and effective alternatives that have replaced the traditional wire. One of the most common is magnetic seed (Magseed) localization.

In this method, days or even weeks before surgery, the radiologist places a non-radioactive magnetic “seed” smaller than a grain of rice into the mass with a needle. The patient returns to normal life.

On the day of surgery, the surgeon uses a special detector (magnetic probe) to locate this seed from the surface of the breast. The device provides audible and numerical signals as it approaches the seed. In this way, the surgeon can enter through the smallest incision at the most accurate point and precisely remove the seed and the attached mass. This method greatly facilitates workflow by separating radiology and operating room schedules and maximizes patient comfort.

What advantages does using ultrasound during surgery (IUGE) provide?

If the surgeon is experienced in breast ultrasound, they can use intraoperative ultrasound guidance (IUGE).

In this technique, the surgeon personally locates the mass during surgery with a sterile ultrasound probe and removes the mass under ultrasound imaging. This method completely eliminates the need for any preoperative marker such as a wire or seed. The surgeon can also confirm that the procedure has been completed by checking with ultrasound in real time while removing the mass.

Is the technique of fibroadenoma surgery different from cancer surgery?

Yes, it is fundamentally different. In a cancer surgery (especially breast-conserving surgery), the goal is to remove the tumor together with a margin of healthy breast tissue (i.e., to obtain a “negative surgical margin”).

However, the situation is different for a mass whose diagnosis has been confirmed as a “benign fibroadenoma” by biopsy. Here, the goal is not to leave no cancerous tissue behind, but simply to remove the mass itself. This is called “enucleation.” The surgeon follows the capsule of the mass and separates it from the surrounding normal breast tissue (like separating a hazelnut from its shell).

In benign fibroadenomas, it is not necessary to obtain wide “negative surgical margins” as in cancer surgery. This approach prevents unnecessary removal of healthy breast tissue, minimizes the postoperative cavity (defect), and thus preserves the cosmetic appearance of the breast in the best possible way.

Why is the removed fibroadenoma specimen sent for an X-ray (specimen radiography) during surgery?

If the mass is non-palpable and was removed using a marker such as a wire or magnetic seed, this is a very important step. The removed tissue (specimen) is sent immediately for an X-ray (specimen radiography) while the patient is still under anesthesia.

On this X-ray, two things are checked: Is the marker (wire or seed) within the removed piece? And is the targeted mass within the removed piece? This confirmation ensures that the correct area has been removed.

What is the recovery process like after surgical excision, and do fibroadenomas recur?

Recovery after a simple lumpectomy is usually quick.

The most common temporary effects after surgery are:

• Localized pain
• Bruising (ecchymosis)
• Blood collection (hematoma)
• Breast asymmetry (in large masses)

When larger masses are removed, asymmetry or indentation may occur in the breast due to volume loss. Therefore, especially in young patients, it is very important for cosmetic outcomes that the surgeon applies “oncoplastic” principles—meaning making the incision in the least noticeable aesthetic areas possible, such as around the nipple or in the inframammary fold.

As for recurrence; yes, it can recur. Even after surgical removal, there is a risk of a new fibroadenoma forming in the same area or elsewhere in the breast. Reported recurrence rates range from 1% to 10%. In particular, if the size of the first removed mass is larger than 2 cm, the recurrence rate has been observed to increase to around 15%. Therefore, it is very important for patients to continue regular breast examinations and imaging (mammography/ultrasound) follow-ups after surgery.

Is non-surgical fibroadenoma treatment possible?

Yes. Today, for fibroadenomas that meet certain criteria (proven benign by biopsy and not very large), there are minimally invasive, scarless methods available without a surgical incision.

Unlike open surgery, these methods can generally be performed under local anesthesia only, in outpatient or day-surgery settings. They eliminate the risks of general anesthesia and provide much higher patient satisfaction and cosmetic outcomes.

What is vacuum-assisted excision (VAE), and how does it work?

VAE (Vacuum-Assisted Excision) is sometimes the therapeutic use of a “vacuum-assisted biopsy” (VAB) device. It is a “percutaneous therapeutic excision” method.

The procedure proceeds as follows: The area is numbed with local anesthesia. Under ultrasound guidance, the surgeon reaches the mass through a small 3–4 mm skin opening using a special needle (probe). While this needle cuts the tissue, it also pulls the cut pieces out with a powerful vacuum system. The surgeon completes the procedure by directing the needle until they see on the ultrasound screen that the mass has been completely “cleared.”

For what sizes of fibroadenomas is the VAE (vacuum removal) method ideal?

The success of VAE is directly related to the size of the mass.

• Below 1.5 cm (15 mm): Success is close to 100%
• Between 1.6 cm and 2.0 cm: Success may drop to 61%
• Above 2.0 cm: The risk of residual tissue remaining increases

For this reason, VAE is the most appropriate method when cosmetic outcome is very important and the mass ideally does not exceed 1.5–2.0 cm. The professional view is that when VAE is attempted in masses larger than 2.0 cm, the risk of residual tissue (residual disease) and related recurrence increases significantly.

What are the advantages and risks of the VAE method?

This method has many advantages.

Its main advantages are:

• No need for general anesthesia
• No stitches or surgical scar
• Excellent cosmetic result
• Fast recovery
• High patient satisfaction
• The removed specimen can be sent to pathology

However, it also has some risks:

Known risks include:

• Hematoma (blood collection)
• Temporary bruising
• Incomplete removal of the mass (if large)
• Recurrence (approximately 9%)

What is cryoablation (freezing) treatment?

Cryoablation is a different minimally invasive method from VAE. In this method, the aim is not to remove the mass but to destroy it by using extreme cold (freezing).

The procedure is again performed under ultrasound guidance and local anesthesia. A special needle called a “cryoprobe” is placed into the center of the mass. The tip of the needle rapidly reaches extremely low temperatures such as -170°C by using argon or nitrogen gas. This forms an “ice ball” within the mass. This ice ball disrupts the structure of fibroadenoma cells and kills them (causes necrosis). The body gradually absorbs these dead tissue remnants over time, and the mass shrinks in volume.

What is the fundamental difference between cryoablation (freezing) and the vacuum (VAE) method?

This is a very important distinction. VAE physically removes the mass and sends it for pathological examination. Cryoablation destroys the mass in place. The mass is not removed; therefore, no pathological examination can be performed after the procedure.

Because of this difference, it is REQUIRED that a mass planned for cryoablation must have undergone a needle biopsy (core biopsy) before the procedure and that the diagnosis is confirmed 100% as a “benign fibroadenoma.” Cryoablation is never performed on a mass with suspicion of cancer or an unclear biopsy result. The success of treatment is not complete disappearance of the mass but shrinkage in volume. In 12-month follow-ups, a 73% to 99% reduction in mass volume has been reported. The goal is for the mass to become no longer palpable.

Are there risks or side effects of freezing treatment (cryoablation)?

Cryoablation is generally a safe and nearly painless procedure.

However, some known side effects include:

• Temporary swelling and bruising
• Skin lightening (depigmentation) at the needle entry site
• Rarely, skin breakdown
• Persistent oily discharge in some patients
• Persistent pain after the procedure (reported in 25% of patients in one study)

Are there other non-surgical methods such as radiofrequency (RFA) or laser?

These are other methods (thermal ablation) that aim to destroy the mass by using heat instead of freezing. Radiofrequency (RFA) or Laser Ablation can also be used in the treatment of fibroadenomas. However, they are not as popular as cryoablation or VAE. Some preliminary comparisons suggest that these thermal (heating) methods may lead to more frequent or more serious complications than cryoablation (freezing), especially skin burns.

What is a “complex fibroadenoma,” and is its treatment different?

A “simple fibroadenoma” is the most common type. A “complex fibroadenoma” is a type that, on pathological examination, contains additional structures such as sclerosing adenosis, cysts larger than 3 mm, or epithelial calcifications, in addition to simple fibroadenoma features.

Complex fibroadenomas are generally seen at an older age (average 47 years). Although the risk of cancer being present within them is slightly higher than in simple fibroadenomas, if there is no accompanying atypia, this risk is still very low (1.6% in one study).

Therefore, the current approach is that even if a biopsy result is “complex fibroadenoma,” if no “atypia” is detected, this mass can also be managed conservatively (i.e., with follow-up), just like simple fibroadenomas.

Frequently Asked Questions

How long is the recovery time after fibroadenoma surgery?

Most patients can return to their daily activities within a few days. Full recovery usually takes 1–2 weeks. Stitches may dissolve on their own or be removed during a follow-up visit.

Is there a risk of recurrence after fibroadenoma surgery?

The removed fibroadenoma does not recur in the same area; however, new fibroadenomas may develop in different areas of the breast tissue. Therefore, regular follow-up is recommended.

In which situations is fibroadenoma surgery definitely recommended?

Surgery is recommended for masses that grow rapidly, cause pain, appear suspicious on imaging, or cause aesthetic discomfort. Surgery may also be preferred in cases where a diagnosis cannot be established.

Will there be a scar after fibroadenoma surgery?

Minimal and aesthetic stitches are generally used. A small scar may remain, but it fades over time and is not noticeable in most patients.

Does breast shape change after fibroadenoma surgery?

With removal of small masses, breast shape is largely preserved. Mild asymmetry may be seen in removals of large or multiple fibroadenomas.

Is breast tenderness experienced after fibroadenoma surgery?

There may be temporary tenderness, swelling, or bruising at the surgical site. These usually resolve on their own within a few days.

Which activities should be avoided after fibroadenoma surgery?

In the first week, heavy lifting, intense sports, and movements that strain the suture line should be avoided. Activities such as light walking are suitable.

How is the risk of infection reduced after fibroadenoma surgery?

Regular wound care, correct dressing application, and monitoring for signs such as redness and discharge reduce the risk of infection.

Are there psychological effects after fibroadenoma surgery?

Aesthetic concerns, uncertainty, and stress may be experienced. A supportive approach or, if necessary, psychological counseling can make this process easier.

Are pregnancy and breastfeeding affected after fibroadenoma surgery?

Surgery generally does not damage breast tissue, so no negative effect on pregnancy and breastfeeding is expected. Nevertheless, follow-up examinations are important.

How Long Does Fibroadenoma Surgery Take?

Fibroadenoma surgery usually takes between 30 and 60 minutes. The surgery can be performed under local or general anesthesia and usually does not require hospitalization.

Which Doctor or Department Should You Go to for Fibroadenoma?

For the diagnosis and treatment of fibroadenoma, you should apply to the general surgery department. General surgeons experienced in breast diseases evaluate the mass and, if necessary, plan biopsy or surgical excision procedures.

At what size is a fibroadenoma removed?

Fibroadenomas can generally be monitored regularly up to 2–3 cm. However, surgical removal may be recommended for fibroadenomas that grow rapidly, exceed 3–4 cm, cause pain, or show suspicious findings on imaging. The decision is made according to the patient’s age, the characteristics of the mass, and the physician’s evaluation.

What should be considered after fibroadenoma surgery?

Rest is recommended for the first few days after surgery. The incision site should be kept clean and dry, and heavy lifting and movements that strain the arm should be avoided. The medications prescribed by the doctor should be used regularly, and follow-up appointments should not be missed.

What are the complications after fibroadenoma surgery?

This surgery is generally safe. Rarely, bleeding, infection, bruising, or seroma (fluid accumulation) may occur. Most complications are mild and are brought under control in a short time with appropriate medical follow-up.

When are stitches removed after fibroadenoma surgery?

Most of the time, aesthetic, self-dissolving stitches are used. If there are stitches that need to be removed, they are usually removed within 7–10 days. The surgical scar loses its prominence over time and blends with the skin tone.

Does a fibroadenoma cause pain?

Fibroadenomas are usually painless. However, tenderness or mild pain may be experienced during periods of intense hormonal changes. Especially in the premenstrual period, the feeling of fullness and discomfort in the breast may increase.