Benign but symptomatic Intraductal papilloma excisional biopsy needed?

Posted by jeaniem @jeaniem, Jun 5 7:36am

I am scheduled to have duct and papilloma removal after mri biospy showed benign papilloma with no atypia. I am second guessing the surgical removal because the linear 2.6 cm area had 12 core samples taken with 9 guage needle and vacuum assist. Biospy was 5 weeks ago and just now getting rid of the severe bruising, hematoma is still there and bloody nipple discharge. My thinking is the mri biospy iitself is enough but surgeon says 5-10% chance of something being missed. I do want to be rid of the clear nipple discharge that was the initial symptom that prompted the biospy. I am 64 with breast density C and family history, but tested negative for braca 1&2.

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Rubyslippers | @triciaot | Jun 5 4:37pm

That’s a tough decision. Didn’t you mention they will be taking the nipple when the papilloma is removed?

I just had my annual series of scan and discussed my papilloma with the survivorship doctor. I was concerned about having other undetected papillomas because that is typical of ones found in the outer areas. She said I didn’t need to worry about other papillomas because the one I had did not have atypia and so they would not expect any others to be a problem.

(I had a papilloma with no atypia which was fully removed during the core needle, 12 gauge 4 samples, biopsy. Mine was peripheral not central. I also had a DCIS next to it.)

One consideration - are they recommending that you do hormone therapy (AI or tamoxifen) after the surgery? If so, it seems that might be enough to just take that now, without surgery if you’re doing hormone therapy. There doesn’t seem to be any rush to go into surgery if they did not find any atypia, especially with 12 samples. 9 gauge must be a large needle.

But this is just my opinion.

jeaniem | @jeaniem | Jun 6 6:54am

Not the whole nipple, just the duct and the papilloma. It was a 2.6 linear lesion, so good sample, but no way to ensure they got it all, so I am told. There has been no discussion about hormone therapy. I do have a follow up appoimtment 2 weeks after the excision. Thank you for your thoughts!

Rubyslippers | @triciaot | Jun 6 12:02pm

Wishing you best outcomes!

It’s our darn dense breasts that seem to be one of the biggest risks. I’ve done a lot of reading and ask many questions; the mammory glands making the breast dense is the problem (as opposed to having breasts mostly made up of fat). For a long time I thought the dense tissue just masked finding a lesion, but my understanding now is that mammory glands that have not totally become involute* after menopause provide a good cancer growing environment. I don’t have BRCA either, my breast density has dropped to B probably from tamoxifen tx.

*” Age-Related Lobular Involution (Lack of Involution)
The Process: As women age (beginning in perimenopause), the terminal ductal lobular units (TDLUs) of the breast normally atrophy and decrease in size and complexity.
The Anomaly: Postmenopausal women who show delayed or incomplete lobular involution (i.e., non-involuted glandular tissue) retain higher mammographic density.”