What is a Breast Papilloma?

A breast papilloma is a small, non-cancerous (benign) growth that forms in the breast’s milk ducts. These growths are typically made up of glandular tissue and fibrous tissue. Breast papillomas are similar to skin warts but develop inside the breast tissue. They can occur in one or both breasts and are usually not harmful, but in some cases, they may increase the risk of developing breast cancer or cause symptoms that need treatment.

Types of Breast Papillomas

1. Solitary Intraductal Papilloma:

• Usually found in the large ducts near the nipple.

• Often causes nipple discharge, which may be clear or bloody.

• May result in a small lump near the nipple.

1. Multiple Papillomas:

• Found deeper within the breast and often involve smaller ducts.

• Less likely to cause nipple discharge but may be linked to an increased risk of breast cancer.

1. Papillomatosis:

• A condition where several small papillomas form within the breast ducts.

• May slightly raise the risk of breast cancer, especially if atypical (abnormal) cells are present.

Left: Papilloma appearance on ultrasound and Right: once removed and under the microscope. 

Treatment Options for Breast Papillomas

1. Observation:

• If a papilloma is small, asymptomatic, and confirmed as benign (non-cancerous), your doctor may recommend regular monitoring with imaging studies (such as mammograms or ultrasounds) to watch for any changes over time.

1. Surgical Removal (Excision):

• If the papilloma causes symptoms (e.g., nipple discharge or pain) or shows signs of atypical cells (which can increase the risk of cancer), surgical removal is often recommended.

• The procedure, called an excisional biopsy, involves removing the papilloma and a small margin of surrounding tissue. It’s typically performed under general anaesthetic with minimal downtime.

• Alternatively, your doctor may recommend a microdochectomy where the duct containing the papilloma is excised. 

• After removal, the tissue is examined to ensure it is benign and contains no cancerous or pre-cancerous cells.

Left: solitary and centrally located papillomas; Right: multiple and peripherally located.

Symptoms of Breast Papillomas

• Nipple discharge: The most common symptom, which may be clear, sticky, or blood-tinged.

• Breast lump: A small lump that can sometimes be felt, especially near the nipple.

• Breast pain: Occasionally, there may be discomfort or tenderness in the breast.

• Nipple changes: Some women notice changes in the nipple, such as inversion or sensitivity.

• Asymptomatic: some women may have a papilloma found as an incidental diagnosis during screening or while investigating other symptoms. 

Diagnosis of Breast Papillomas

If you notice symptoms such as nipple discharge or feel a lump, your healthcare provider may recommend several tests to diagnose a breast papilloma, including:

• Physical Examination: Your doctor will examine your breasts and feel for lumps or abnormalities.

• Imaging Studies:

• Mammogram: A detailed breast X-ray to look for any unusual growths or changes in breast tissue.

• Ultrasound: Often used in conjunction with a mammogram, ultrasound helps to differentiate solid masses (like papillomas) from fluid-filled cysts.

• Biopsy: If imaging suggests a papilloma, a small tissue sample may be taken for examination to confirm the diagnosis and check for any abnormal (atypical) or cancerous cells. A smear of any discharge may also be taken for pathological examination. 

Potential Risks and Complications

• Increased Breast Cancer Risk: While most breast papillomas are benign, the presence of multiple papillomas or atypical cells may slightly raise your risk of developing breast cancer. Regular follow-up with your doctor is important in these cases.

• Recurrence: In rare cases, papillomas can recur after they are removed.

• Surgical Risks: As with any surgery, there are potential risks such as infection, bleeding, and scarring, although these are uncommon and usually minor.

Conclusion

Breast papillomas are common and typically benign growths. While they are usually not harmful, it’s important to monitor for any changes or symptoms. If you experience nipple discharge, pain, or a lump, speak to your doctor for further evaluation. Surgical removal is often recommended when symptoms occur or if there is a concern for abnormal cells. Regular follow-ups are key to maintaining breast health and early detection of any potential issues.