Preserving Cosmesis in Giant Fibroadenoma Surgery: Circumareolar Swiss Roll Versus Saw-Tooth Approach

Background: Giant fibroadenomas are defined as breast fibroadenomas larger than 5 cm—are uncommon benign lesions that often cause significant breast distortion, particularly in younger women. Surgical excision is the treatment of choice; however, traditional approaches may result in undesirable scarring and aesthetic compromise. Objective: This study compares two minimally invasive circumareolar surgical techniques—the Saw-Tooth and Swiss Roll methods—for the excision of giant fibroadenomas, with an emphasis on cosmetic outcomes, surgical feasibility, and preservation of breast architecture. Methods: Both techniques were performed via a circumareolar incision, offering direct access while minimizing visible scarring. The Saw-Tooth technique involved alternating partial incisions on the mass to facilitate gradual extraction, whereas the Swiss Roll technique employed spiral enucleation through a smaller incision. Intraoperative parameters, cosmetic outcomes, and specimen integrity were compared. Conclusion: Both methods proved effective for complete tumor excision with minimal complications. The Swiss Roll technique demonstrated superior cosmetic outcomes and better specimen preservation, making it more suitable for histopathological evaluation. The Saw-Tooth method, while technically easier, involved partial fragmentation of the mass but still achieved satisfactory aesthetic results. Circumareolar approaches offer safe, cosmetically favorable options for managing giant fibroadenomas in young patients. Selection between the SawTooth and Swiss Roll techniques should be based on tumor characteristics and surgeon experience, with both techniques yielding excellent outcomes when appropriately applied.