Intraductal papilloma

Intraductal papilloma is a benign (not cancer) breast condition where a wart-like lump develops in 1 or more of the milk ducts in the breast. It’s usually close to the nipple, but it can be found anywhere in the breast.

You may have a single intraductal papilloma. Or you may have multiple intraductal papillomas, also called papillomatosis.

It’s most common in women over 40 and usually develops naturally as the breast ages and changes.

A rarer condition called juvenile papillomatosis affects teenage girls and younger women.

Men can also get intraductal papillomas, but this is very rare.

Although the names are similar, intraductal papilloma is not the same as papillary breast cancer.

You may notice:

• A lump in the breast
• Discharge of clear or blood-stained fluid from the nipple 

An intraductal papilloma is not usually painful, but you may have some discomfort or pain around the area. 

A single intraductal papilloma does not increase the risk of developing breast cancer.

If you have multiple intraductal papillomas, you may have a slightly higher risk of developing breast cancer. 

Some intraductal papillomas contain cells that are abnormal but not cancer. These are called atypical cells. Having atypical cells has been shown to slightly increase the risk of developing breast cancer in the future. 

Intraductal papillomas can be found:

• During routine breast screening
• After breast surgery, for example to treat nipple discharge
• If you go to your GP with symptoms 

You will be referred to a breast clinic where you’ll see specialist doctors or nurses.

Tests you may have

At the breast clinic you’ll have a range of tests to help make a diagnosis. These may include:

• A breast examination
• A mammogram
• An ultrasound scan
• A core biopsy
• Fine needle aspiration (FNA)
• A vacuum assisted biopsy

If you’re under 40, you’re more likely to have an ultrasound scan than a mammogram. Younger women’s breast tissue can be denser, which can make a mammogram less clear. However, some women under 40 may still have a mammogram.

Intraductal papillomas are often removed using surgery. 

Excision biopsy 

You may be offered an operation called an excision biopsy to remove the intraductal papilloma. This can be done under a local or general anaesthetic. 

The breast tissue removed will be examined under a microscope, which can help confirm the diagnosis. 

Your surgeon may use dissolvable stitches placed under the skin. These will not need to be removed. However, non-dissolvable stitches will need to be taken out a few days after surgery. Your treatment team will give you information about this and about looking after the wound. 

The operation will leave a scar, but this will fade over time.

Vacuum assisted excision biopsy 

You may be offered a vacuum assisted excision biopsy to remove the intraductal papilloma. 

After an injection of local anaesthetic, a small cut is made in the skin. A special needle connected to a vacuum device is placed through this cut.

Using a mammogram or ultrasound as a guide, breast tissue is sucked through the needle into a collecting chamber. This is done until the area being investigated has been removed.

The tissue removed is sent to a laboratory to be examined under a microscope.  

This procedure can cause some bruising and pain for a few days afterwards, but it can mean you may not need an operation under a general anaesthetic.

Further surgery 

If you’ve had surgery and continue to have discharge from your nipple, you may need to have another operation to remove:

• The affected duct or ducts (microdochectomy)
• All the major ducts (total duct excision, also known as Hadfield’s procedure)

The operation is usually done under a general anaesthetic.

You’ll normally have surgery as a day case, which means you’ll be admitted to hospital in the morning and sent home later the same day. But you may need to stay overnight. 

You will have a small wound near the darker area of skin around the nipple (areola) with a stitch or stitches in it. Your treatment team will give you information about how to care for the wound and advice about pain relief.

You may notice some changes in sensation in the breast or nipple area in the weeks after the operation. This can include sharp, stabbing or shooting pains. This is normal.

You may have some bruising, and the operation will leave a small scar which will fade over time. Your nipple may be less sensitive than it was before the operation. 

If you’ve had a total duct excision, you will not be able to breastfeed from that breast. However, you may be able to breastfeed from the breast if you have had a microdochectomy.

Most people can return to work after a couple of days. Your treatment team will let you know if there is anything else to consider while you recover.

The operation should stop the discharge from occurring. However, finding all the ducts can sometimes be difficult. You may need to have more ducts removed if the discharge returns.

You may need to go back to the breast clinic to check how your wound is healing after surgery.

If you had a single intraductal papilloma removed, you will not usually need to go back to the breast clinic for any follow-up appointments.

You’re more likely to have follow-up appointments if you had multiple intraductal papillomas or intraductal papillomas that contained atypical cells. 

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.