What is an intraductal papilloma?
Breasts are made up of lobules (milk-producing glands) and ducts (tubes that carry milk to the nipple), which are surrounded by glandular, fibrous and fatty tissue.
Sometimes a wart-like lump develops in one or more of the ducts. It’s usually close to the nipple, but can sometimes be found elsewhere in the breast. You may feel a small lump or notice a discharge of clear or bloodstained fluid from the nipple. Generally intraductal papillomas aren’t painful but some women can experience pain around the area. All of these may be symptoms of an intraductal papilloma.
Intraductal papillomas can occur in both breasts at the same time and are sometimes found by chance following breast surgery. They are benign (not cancer) and generally do not increase the risk of developing breast cancer. They are most common in women over 40 and usually develop 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
- 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 of this 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 excision biopsy may be used as an alternative to surgery. Following an injection of local anaesthetic, a small cut is made in the skin. A hollow probe connected to a vacuum device, is placed through this.
Using ultrasound or mammography as a guide, breast tissue is sucked through the probe by the vacuum into a collecting chamber. The biopsy device is used until the area being investigated has been removed. This may mean that an operation under a general anaesthetic can be avoided. The tissue removed is sent to the laboratory and examined under a microscope.
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 look after this and give you advice about pain relief. 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.