What to expect from a fibroadenoma removal?

August 22, 2012 1:48 PM

I am having a benign fibroadenoma removed from my breast. What can I expect during and after the surgery?

I have a large (1", grape-sized) fibroadenoma in the 10 o'clock position. It is just under the skin (visible to the eye; it's not very deeply hidden under my skin), closer to my armpit than my nipple. It has been biopsied but since it has grown recently I am having it surgically removed based on the recommendations of my primary care provider, gynecologist, and breast specialist. If you have had this surgery, I have a lot of questions:
-How painful is this? How long were you on pain medication, and what kind?
-How bad was your bruising and how long did it last? I generally bruise easily; does this mean I'm likely to bruise quite badly?
-I'm not sure if I'm getting twilight sedation or real anesthesia (yes, I will be asking my doctor!)--is one preferable to the other?
-What is the recovery like? I'm taking three days off work as recommended by the doctor; will I feel pretty much better by day 4, or will I be tired for awhile?
-Is there anything I can do before or after the surgery to speed my recovery? (I will also be asking my doctor this.)
-When were you able to wear a bra again? Will I be stuck wearing a loose sports bra for weeks or will I be able to wear my regular (high-end) bras? Or do I need a super supportive new bra? Will I need to sleep in a bra?
-When did you return to normal activity, especially things like typing, dressing yourself, and cooking, and exercise like running or weight lifting? Did the surgery impact your ability to use your arm for awhile or did it not really impact your hand/arm at all? (I am right-handed and this is on my right side.)
-Did another fibroadenoma develop after the surgery, or have you been lump-free since?
-Is there anything not-obvious I should ask my doctor?
-Do you have any other tips or words of wisdom for me?

I am in my mid-thirties, in good shape, I don't smoke, and my husband is taking two days off to care for me after the surgery. I am only interested in responses about the surgery and recovery; I am comfortable with the decision to have surgery and do not want answers suggesting I don't have it. This is anonymous due to the large amount of personal health information in the post, but you can email me at [e-mail] if you would rather not post here. I have seen this similar question (http://ask.metafilter.com/180980/Having-a-lump-removed-from-my-breast) but have more specific questions that were not addressed so I wanted to ask again. I also noticed there was a lot of variability in the answers on that question, so if you could talk about the size/location of your lump in your answer that would be awesome! (ie, are recoveries worse if the lump is really deep, or really large, or does it really just depend on the person?)

Thank you! I am fairly nervous about this (especially the anesthesia part) so would really appreciate your answers.

posted by anonymous to Health & Fitness (6 answers total)

One reason you may bruise easily is a lack of Vit C, so I would initially recommend taking a multivitamin a day for a few days before and after surgery. Secondly use regular doses of over the counter meds to keep the pain and inflammation under control and this will help with the bruising. It very much depends on exactly which vessels are cut so it's quite individual but generally a superficial mass in the upper outer-quadrant will not create a lots of bruising.

Have a look at this AskMe where my partner responded about NSAIDs especially what he says about dosage intervals. (he is also the anaesthetist for the breast team here and he says good pain control is essential in getting back to normal, it does not need huge strong drugs, although they act well in the short term immediately after the op so if offered them, take them!)
His advice was if twilight sedation is offered GO FOR IT! You are the ideal candidate for it. If possible bring your favorite music and earphones and accept there will be some pulling and dragging. You will not remember most of this afterwards as they use a retrograde amnesiac. Also they irrigate 8-10mls of local anaesthetic into the wound which helps. To be honest these days General Anesthetics are quite short acting so don't assume this is the worst option! Honestly if you've never been operated on before you may still have an outdated sense of GA.



I think the big surprise is how emotional you may feel post-op, and that's caused by a combination of factors. Also you will be surprised depending on how you use your body, for example, if you are the type of person who gets up from bed in the morning and does a big stretch, or from your desk at work and stretch your arms above your head as an automatic movement, you'll need to be careful. The dressings are there but they don't stop that kind of automatic muscle memory so maybe try to strap or tape the area to remind yourself not to over-reach.

another tip, increase your protein intake now and until you've healed to increase healing. Being a non-smoker the chances of post op infection are tiny so good for you.

check the clothing you'll wear afterwards. That quadrant is where bra-straps or seams can rest (by 10 0 clock I'm guessing you mean upper-outer quadrant of right breast? Don't know if it's from your POV or the surgeons's POV). The dressing provides some cushioning but not if something is chaffing.

best of luck with it!
posted by Wilder at 3:04 PM on August 22, 2012

I had one removed in the early 90's. I was in my early 20's at the time. It was about the same size as yours. It was really not a big deal at all.

I had local anesthesia and remember the whole thing. It only took about half an hour. I drove myself home, took a nap, and I don't think I even told my housemate where I'd been that day. I went back to work the next day and didn't modify my daily routine at all. At the time, I was working at Kinko's and regularly hauled around 50 lb boxes of paper, and I don't remember having any trouble with it. I also don't remember any pain at all. I didn't get (or need) any prescription pain meds, though I probably took some tylenol afterwards.

The thing is, it is just not that big a surgery. Your lump is probably, what, a centimeter below the skin? They make a tiny little cut, pop it out, and put in a couple of stitches.

At the time, the doctor was very pleased with himself about how neat the incision was. He made the incision in a semicircle around the edge of the nipple, so no scarring would be visible. You might want to ask about the scarring. I didn't appreciate it at the time, but that doctor did do a damn fine job - there is no scarring at all.

Also, he said I'd have no trouble breastfeeding if it ever came up in the future. Ten years after the surgery, I was breastfeeding and it was fine. So ask about that if it might be a concern.
posted by selfmedicating at 5:03 PM on August 22, 2012

Background: I found a lump in my breast in my early 20s, it was biopsied and came back benign. It was about 1" and round, same as yours. We decided to let it sit for a while, but it started growing and causing pain so I had it surgically removed. All of your questions, with my answers in-line:

-How painful is this? How long were you on pain medication, and what kind?
-- My breast felt achey and sore, like a bad bruise, for about a week. It wasn't bad enough to warrant any pain medication stronger than Advil -- none was offered and I never felt liked I needed any. I also used an ice pack quite a bit in the first few days.

-How bad was your bruising and how long did it last? I generally bruise easily; does this mean I'm likely to bruise quite badly?
-- I don't remember the bruising being anything special. It was all gone by the time I was cleared to wear a normal bra and remove the dressing, so I wasn't really concerned about it being revealed anyway (e.g. I wouldn't have been wearing a swimsuit).

-I'm not sure if I'm getting twilight sedation or real anesthesia (yes, I will be asking my doctor!)--is one preferable to the other?
-- I had real anesthesia -- twilight wasn't offered to me. I honestly don't know how deep mine was but it wasn't visible through the skin, so I'm guessing twilight wasn't an option.

-What is the recovery like? I'm taking three days off work as recommended by the doctor; will I feel pretty much better by day 4, or will I be tired for awhile?
-- I don't know if I felt a systemic fatigue for longer than a couple days after the surgery. The two things that stick in my mind about the recovery the most are feeling physically awkward (feeling like I shouldn't do things with my arm on the side where I had the lump removed) and being really uncomfortable sleeping in a bra.

-Is there anything I can do before or after the surgery to speed my recovery? (I will also be asking my doctor this.)
-- Rest, healthy food, lots of fluids.

-When were you able to wear a bra again? Will I be stuck wearing a loose sports bra for weeks or will I be able to wear my regular (high-end) bras? Or do I need a super supportive new bra? Will I need to sleep in a bra?
-- I had to wear a supportive sports bra for at least a week straight after the surgery... my mind might be playing tricks on me but it's possible it was actually two weeks. Slept in it as well. This drove me CRAZY. However, my lump was on the underside of the breast (around 6:30) so gravity might have been working against me more than it will be for you.

-When did you return to normal activity, especially things like typing, dressing yourself, and cooking, and exercise like running or weight lifting? Did the surgery impact your ability to use your arm for awhile or did it not really impact your hand/arm at all? (I am right-handed and this is on my right side.)
-- It didn't affect my fine motor control at all. I was cleared to return to normal day to day activity after two weeks (I believe the example they gave was lifting a gallon of milk), and weightlifting (I lift heavy weights, like 100+ lb) after four weeks. I didn't have a problem dressing myself, typing, or cooking at any point in the process. In fact, I had to put my sports bra on myself just a few minutes after waking up from surgery... mentally I was a little fiddly but physically it wasn't a problem :)

-Did another fibroadenoma develop after the surgery, or have you been lump-free since?
-- Mine was actually a hamartoma (another kind of benign tumor), but I'm still lump free 18 months later.

-Is there anything not-obvious I should ask my doctor?
-- If you have sensitive skin, you might ask about a hypoallergenic dressing in advance. The hospital used the standard dressing on me (kind of a sticky plastic stuff) and after a few days the area was horrendously itchy and hot to the touch, so I got scared that I was getting an infection. I was just having a normal, quite common, sensitive skin reaction to the dressing.

-Do you have any other tips or words of wisdom for me?
-- My biggest concerns were cosmetic. I was scared my breast would be deformed from having a lump of it removed, and that the scar would be hideous and awful. I can't make any guarantees about your outcome, but I can tell you that however it looks in the weeks after surgery, it will look a BAJILLION times better in a year. Even moreso if you're disciplined in applying a high quality scar cream. Plenty of people have seen my bare breast since the surgery and no one has ever noticed my scar without having it pointed out to them.
posted by telegraph at 7:38 PM on August 22, 2012

I had one removed in the late 90s when I was 19, I think. It was super-easy and not traumatic at all. Mine was located about 12 o'clock.

-How painful is this? How long were you on pain medication, and what kind?
I don't remember any major pain, and I certainly didn't take anything stronger than an OTC pain reliever.

-How bad was your bruising and how long did it last? I generally bruise easily; does this mean I'm likely to bruise quite badly?
I had it done over the summer and bruising was pretty well gone by the time I returned to college.

-I'm not sure if I'm getting twilight sedation or real anesthesia (yes, I will be asking my doctor!)--is one preferable to the other?
I had a local and that was it...it may have been some kind of block on that side.

I don't remember enough to answer your other questions in any detail, sorry. I just know that I had no complications and have been lump-free ever since (besides being fibrocystic anyway). Recovery was a breeze, but I don't remember about the bra thing. I do still have a scar, but it's barely visible now, 15 years later.

Try not to stress too much, and good luck!
posted by altopower at 9:01 AM on August 23, 2012

I had one removed in the mid-80s, under full anaesthetic. I remember some pain (it was a large lump about 2" across, at about 11 o'clock) and the bruising took a few weeks. I was signed off work for two weeks.

I had another one come back in the same place in 2006. Mammograms,ultrasound, needle and core biopsies were inconclusive so it was removed, again under full anaesthetic. My stitches got slightly infected so I was off work for about 3 weeks, I think, in total. It was benign.
posted by essexjan at 12:22 PM on August 23, 2012

[This is a followup from the asker.]

Thank you all for your thoughtful answers. Telegraph and Wilder, yours were most especially helpful, but I would mark all best answers if I could! I had the surgery four weeks ago today.

For anyone else seeking information on this: the surgery was not as bad as I thought it would be! I had virtually no pain from the incision--I needed one tylenol that night and that was it. I couldn't believe it! I had far more pain from the IV insertion site, which bruised very badly. The bruising on both my hand and breast lasted about three weeks. I was extremely tired for a week or so, and then less so for a couple more weeks. I couldn't do much of anything for the first couple of days--not even skooch myself up in bed or carry a glass of water--but once that went away I felt a lot better. I found I really craved red meat and felt better after eating it. I wish my doctor had warned me better about the reaction to the anesthesia (in terms of grogginess) and about how tired I would be--I felt unprepared for that. I had to work short days my entire first week back at work, as I just got too tired to finish out the day.
I wish I had asked for the hypoallergenic dressing--I did not and got a reaction. It went away after about two weeks. I found wearing a bra 24-7 for over a week to be very uncomfortable, and I wish I had invested in a nursing or sleep bra! I needed the support of an underwire and my sports bras squashed my breast too much to wear them.
My doctor also told me after the surgery to expect the area to be a bit hard and lumpy for 2-3 months, and so far that has been true. However, four weeks out my incision is healed, I have no pain unless I lie directly on that breast at a weird side/face angle (although my breast was more tender than usual at my last period), and no limitations on my activities. I was able to start weight lifting after about 2 weeks and running after about 3 weeks.

posted by cortex at 9:28 AM on October 17, 2012