Breast papillomas are non-cancerous growths that develop within the milk ducts. This article clarifies when these growths require removal and what the process entails.
Understanding Breast Papillomas
Breast papillomas are benign, wart-like growths within the milk ducts. They typically range from 1 to 2 centimeters in size. These growths are often categorized by their location and number.
Solitary papillomas usually form in larger milk ducts closer to the nipple and commonly cause nipple discharge, which can be clear or bloody. Multiple or peripheral papillomas are found in smaller milk ducts deeper within the breast and are less likely to cause discharge. Multiple papillomas (papillomatosis) occur in younger individuals and may have a slightly elevated risk for future breast changes.
Atypical papillomas contain atypical cells, such as atypical ductal hyperplasia (ADH), within or near the growth. These cells indicate a higher potential for developing more significant breast conditions, making careful evaluation important.
When Removal is Recommended
Not all breast papillomas require removal; the decision depends on several factors. Removal is recommended for diagnostic uncertainty, especially if an initial biopsy (e.g., core needle biopsy) cannot definitively confirm the growth’s benign nature or rule out atypical features. This can occur due to insufficient tissue or ambiguous findings.
The presence of atypical cells (e.g., atypical ductal hyperplasia or ADH) found during initial biopsy also warrants removal. These findings indicate a higher potential for more serious conditions. Studies show that papillomas initially diagnosed as benign on core biopsy can be upgraded to atypia or malignancy after surgical excision.
Papillomas causing bothersome symptoms, like persistent nipple discharge (especially if bloody) or a palpable lump, are also candidates for removal. Some individuals may choose removal for reassurance. For simple, solitary papillomas without atypia or symptoms, monitoring with regular imaging may be considered.
The Removal Process and Follow-Up
Common methods for removing breast papillomas include surgical excisional biopsy and vacuum-assisted biopsy (VAB).
Surgical excision, an outpatient procedure, removes the papilloma with a small margin of surrounding tissue. This ensures complete removal and provides tissue for pathological examination. A scar will fade over time, and temporary changes in breast sensation may occur.
Vacuum-assisted biopsy (VAB) is a less invasive procedure for removal, especially for smaller lesions. A specialized needle removes tissue under imaging guidance. VAB can remove the entire lesion in some cases, reducing the need for open surgery, and is useful for diagnosis or therapeutic intervention for benign lesions.
After removal, excised tissue is sent for pathological analysis to confirm the growth’s nature and check for atypical or malignant cells. Recovery involves mild discomfort and bruising, with most individuals returning to normal activities within days. Follow-up care is important, especially for those with multiple papillomas or atypical cells, requiring regular monitoring for recurrence or new lesions.