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BACKGROUND: Fibroadenomas are benign breast tumors; however, more aggressive lesions may mimic or arise within fibroadenomas. We sought to define criteria identifying patients who should undergo surgical excision. METHODS: Patients with a preoperative diagnosis of fibroadenoma, who underwent surgical excision between 2002 and 2011, were retrospectively reviewed. Patients with final pathologic diagnosis of fibroadenoma were compared with those with non-fibroadenoma pathology. RESULTS: Of the 723 patients, 681 (94%) had fibroadenomas on final pathology. The incidence of non-fibroadenoma pathology was 6% (42 patients) and included benign phylloides (23), malignant phylloides (2), atypical ductal hyperplasia (1), intraductal papilloma (5), and other benign pathology (11). No cases of adenocarcinoma were identified. Non-fibroadenoma pathology was associated with age >35, immobile or poorly circumscribed mass, size >2.5 cm, and biopsy not definitive for fibroadenoma. CONCLUSION: Patients with age >35 years, immobile or poorly circumscribed mass, size >2.5 cm, or biopsy not definitive for fibroadenoma should undergo surgical excision. [ABSTRACT FROM AUTHOR]