Intraductal papilloma

What is an intraductal papilloma?

Sometimes a wart-like lump develops in a duct just behind the areola. This is an intraductal papilloma.

You may notice a small lump under the areola and/or a discharge of clear, sticky or bloodstained fluid from the nipple. You may also feel some pain.

Intraductal papillomas can be in both breasts at the same time and are sometimes found by chance following breast surgery. They are benign (non-cancerous) and generally do not increase the risk of developing breast cancer. They are most common in women over 40 and usually develop naturally as the breast ages and changes.

However, when an intraductal papilloma contains atypical cells (abnormal but not cancerous), this has been shown to slightly increase the risk of developing breast cancer in the future. Some people have multiple intraductal papillomas and they also have a slightly higher risk of developing breast cancer.

How are they found?

After a breast examination your GP is likely to refer you to a breast clinic for tests.

A triple assessment will provide a definite diagnosis, comprised of a breast examination, a mammogram or ultrasound scan and a fine needle aspiration cytology (FNA) or core biopsy/vacuum assisted biopsy.

If you have discharge from the nipple, rather than a lump, a sample will be sent to the laboratory to be looked at under a microscope.

Treatment and follow up

Your specialist will be able to advise you of the most appropriate treatment or follow up (further checks) if you have an intraductal papilloma. They may feel that no further treatment is needed after either a core or vacuum assisted biopsy. However, they may still want to do another operation (excision biopsy) to remove more breast tissue. In some centres, vacuum assisted biopsy may be used as an alternative to surgery.

If your nipple continues to produce discharge after surgery, or if there’s inflammation around it, you may need to have a further operation to remove the affected duct or ducts. You may be offered a microdochectomy (removal of the affected duct or ducts) or a Hadfield’s operation (removal of all the major ducts). The operation should solve the problem, but if the discharge comes back more ducts may need to be removed, as finding all the ducts can sometimes be difficult.

The operation is usually done under a general anaesthetic, and you’ll be in hospital for the day or overnight. You’ll have a small wound near the nipple with a stitch or stitches in it, and your doctors will tell you how to care for it afterwards. If your breast is painful after the operation, you may want to take pain relief such as paracetamol. The operation will leave a small scar but this will fade in time. After the operation your nipple may be less sensitive than before.

After the intraductal papilloma has been removed, follow up is not usually required. However, for some people, a short-term follow up with the specialist may be needed if only a core biopsy/vacuum assisted biopsy has been performed. People with multiple intraductal papillomas and those whose intraductal papillomas contained atypical cells are likely to have follow up appointments with their specialist for longer.

What this means for you

You may feel anxious about having an intraductal papilloma. Even though you may feel relieved that it’s a benign condition, you may still worry about breast cancer. For most people, having an intraductal papilloma does not increase their risk of breast cancer.

If your intraductal papilloma contains atypical cells, or if you have multiple intraductal papillomas, you may be worried or anxious that your risk of breast cancer is slightly increased. This doesn’t mean you’ll necessarily develop breast cancer in the future.

Even though your intraductal papilloma has been removed, it’s still important to be breast aware and go back to your GP if you notice any other changes in your breasts.