Surgery for giant tumours of the breast: a 15 year review

Abstract

Background: Giant tumours of the breast tend to occur in the adolescent age group. Racial predilection has been noted in the literature. The mass often occupies most of the breast, leading to its distortion. Many authors have advocated a mastectomy for benign tumours that severely distort the breast. Giant benign tumours when treated by simple excision risk persistence of asymmetry. To avoid this asymmetry, some authors have resorted to excision and immediate reduction mammaplasty. The aim of this retrospective study was a report on giant tumours of the breast presenting to a plastic surgery unit and to analyse demographic factors, clinical presentations, tumour pathology, management, complications, as well as patient and breast outcomes. Methods: Medical records of patients with giant tumours were retrospectively analysed for assessing demographic factors, clinical presentation, tumour pathology, the technique of surgery performed and patient and breast outcomes in a single hospital setting. Breast outcomes were rated by panel of 4 experienced plastic surgeons using the 4 Point Likert scale. Their ratings were statistically analysed for inter-rater agreement. Results: Twenty-three subjects were identified to have giant tumours of the breast. Of these South African patients, 19 were black, 3 were Indian and 1 was of mixed ethnicity. The age range was 12-49 years(y) with an average of 19y. All masses were palpable. The final pathological diagnosis was fibrocystic disease in 3, giant fibroadenoma in 14, phyllodes tumour in 4, and hamartoma in 2. The size range was 10-45 cm with a median size of 18 cm. All but one patient had simple excision followed by immediate reduction mammaplasty. Twenty patients were assessed after operation. A minimum of 1 to a maximum of 4 patients per reviewer showed unsatisfactory outcomes and a minimum of 18 to a maximum of 21patients per reviewer showed satisfactory to excellent outcomes. The overall agreement between assessors for this was 84%. Conclusion: Benign giant tumours (> 10 cm) of the breast are suitably managed by excision of the mass and a reduction mammoplasty technique of reconstruction. Keywords: Giant tumour breast reduction mammaplasty, giant fibroadenoma of breast, phyllodes tumour, hamartoma breast S Afr J Surg 2018;56 (3) http://dx.

A National Review of Insurance Coverage of Noncancerous Breast Reconstruction

“…Current guidelines for Poland syndrome recommend that reconstruction be evaluated continuously, as the soft tissues involved in Poland syndrome are susceptible to change based on a multitude of factors including age, weight fluctuations, and exercise level 9 . Finally, multiple procedures may be required to correct asymmetry due to fibrocystic breast disease; this condition frequently affects the 17- to 20-year age group and severity may fluctuate over the patient's lifetime 20,21 . Repeated procedures increase cost to the insurer and therefore provide a reason to limit insurance coverage of breast reconstruction.…”

Lipomodelling of the Breast Following Excision of a Giant Juvenile Fibroadenoma

“…Various surgical techniques have been reported in the literature. While some authors recommended simple enucleation of the mass using appropriately sited peri-areolar or inframammary cosmetic incision relying on the remaining displaced breast tissue to fill in the space left by the excised giant fibroadenoma so negating the need for reconstruction, others advised the use of mastopexy or reduction mammoplasty technique using the inverted T-incision technique [4,9,[11][12][13][14][15][16]. Achebe et al considered significant breast asymmetry, i.e., the difference in the position of the nipple areola complex of 6 cm, as an indication for reduction mammoplasty [17].…”

Factors leading to delayed and challenging presentation of benign breast lumps in young females

“…Simple surgical excision in larger and multiple lesions result in a displeasing, loose, ptotic breast and may require secondary surgery or even removal of entire breast. 5 Thus surgeon has to face a reconstructive challenge similar to when a large malignant neoplasm is removed. 6 Recently, with the invent of oncoplastic breast surgery, breast conservation with good aesthetic results are seen but this needs specialized skills and training.…”