Breast lumps surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shadan Mehraban, M.D.[2]

Overview

Surgical management of breast lumps depends on the type of masses based on core-needle biopsy. Atypical ductal hyperplasia, atypical lobular hyperplasia, lobular neoplasia, lobular carcinoma in situ, flat epithelial atypia. Multiple, peripheral and atypic papillomas, large sclerosing adenosis and radical scar >10mm, atypic and enlargic fibroadenomas, desmoid tumor, mammary fibromatosis, phyllodes tumor, symptomatic and large pseudoangiomatous stromal hyperplasia requires surgical consultation and excision. The rest of breast lumps require observation and follow-up. The final decision for excisional biopsy is based on recommendations from pathologist, radiologist, and surgeons.

Surgery

Management of breast lumps after confirmation on the basis of core needle biopsy:

Breast lump	Surgical management
Atypical ductal hyperplasia	Excision of lump by surgical consultation and follow-up with clinical breast examination every 6-12 months accompanied with mammography, annually.
Atypical lobular hyperplasia, lobular neoplasia, lobular carcinoma in situ	Surgical consultation and follow-up with clinical breast examination every 6-12 months accompanied with mammography, annually.
Flat epithelial atypia	Surgical consultation and follow-up with clinical breast examination every 6-12 months accompanied with mammography, annually.
Papillomas	Multiple, peripheral papillomas, lesions with atypia, and size >10 mm require surgical consultation and follow-up with clinical breast examination every 12 months and mammography, annually.
Complex sclerosing lesion, radical scar	If the size < 10mm and adequately sampled: observation. If the size > 10mm: surgical consultation is required. If papilloma is excised: follow-up with annual clinical breast examination and mammography.
Fibroadenoma	If accompanied with atypia and enlarging size, surgical consultation is required. Follow-up with annual clinical breast examination and mammography.
Complex fibroadenoma	Observation and follow-up with clinical breast examination and mammography, annually.
Sclerosing adenosis	Observation and follow-up with clinical breast examination and mammography, annually.
Fat necrosis	Observation and follow-up with clinical breast examination and mammography, annually.
Columnar cell hyperplasia	Observation and follow-up with clinical breast examination and mammography, annually.
Phyllodes tumor	Surgical consultation is required with follow-up with clinical breast examination and mammography, annually.
Desmoid tumor and mammary fibromatosis	Surgical consultation is required with follow-up with clinical breast examination and mammography, annually.
Pseudoangiomatous stromal hyperplasia:	In symptomatic and large lesions, surgical consultation is required with annual clinical breast examination and mammography follow-up.
Apocrine metaplasia	In discordant and atypic lesions, surgical consultation is required and in case of excision,follow-up with clinical breast examination and mammography annually.

The final decision for excisional biopsy is based on recommendations from pathologist, radiologist, and surgeons. The decision is made after comprehensive evaluation of clinical, imaging and pathological findings which help to reach the best possible management for patient care.

References

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