Senology · Paris 8th & Neuilly
Breast Surgery Benign & at-risk lesions Dr Jérémie Zeitoun · Breast Surgeon Paris 8th
Lump, abnormal mammogram, biopsy result? Dr Zeitoun helps you see clearly and make the right decision.
Scroll
Lump, abnormal mammogram, biopsy result? Dr Zeitoun helps you see clearly and make the right decision.
The vast majority of breast abnormalities are benign. But certain situations warrant a prompt consultation — to get a clear answer, and not to remain with an unevaluated concern.
I consult in Paris 8th and in Neuilly-sur-Seine. I also offer teleconsultations for patients coming from a distance.
Certain lesions found on biopsy are neither cancer nor clearly benign — they are called "at-risk" lesions because they slightly increase the lifetime risk of developing breast cancer. They require specific management and enhanced surveillance.
What it is. ADH is an atypical epithelial proliferation inside the breast ducts — abnormal but not yet a cancer. It is considered the highest-risk B3 lesion. ADH is silent (no discharge, no palpable nodule) and is most often detected on screening mammography as a focus of ACR 4 microcalcifications. It multiplies by 4 to 5 the lifetime risk of developing breast cancer, bilaterally.
What is done. The diagnosis is established by stereotactic vacuum-assisted excision (Mammotome) with placement of a metal clip (Twirl type). A surgical excision is near-systematic (SENORIF 2025-2026) because 10 to 25% of ADHs reveal an underlying cancer on the specimen. A pre-operative localisation is placed at the metal clip (wire localisation/hookwire or magnetic seed — Magseed, Localizer, Sirius). Re-excision is never performed, even if margins are involved or residual atypia is found — only the discovery of an associated cancer changes management. No chemoprevention (tamoxifen, raloxifene) is offered.
Follow-up. Mammo-ultrasound at 6 months post-op (± MRI if initial diagnosis was made by MRI), then annual bilateral mammography + ultrasound (± MRI depending on context) for at least 10 years. → Read the detailed ADH page.
What it is. ALH is an abnormal proliferation of cells in the breast lobules (milk-producing glands). Like ADH, it is not a cancer but carries an increased risk — multiplied by 4 to 5 — applicable to both breasts (bilateral risk).
What is done. Surgical excision is discussed according to the context (extent, imaging discordance, associated lesions). Enhanced annual surveillance is the cornerstone of management.
What it is. LCIS is often an incidental finding on biopsy. Despite its name, it is not a true cancer — it does not invade surrounding tissue and does not spread to lymph nodes. It is above all a bilateral risk marker: its presence multiplies by 8 to 10 the lifetime risk of breast cancer in either breast.
What is done. Surgical excision is discussed in certain situations (pleomorphic variant, imaging discordance). Enhanced annual surveillance (mammogram + MRI) is the reference management. Chemoprevention (tamoxifen or raloxifene) may be discussed.
What it is. An intraductal papilloma is a small outgrowth that develops inside a breast duct. It often causes unilateral nipple discharge, sometimes bloody. It may be single (central, near the nipple) or multiple (peripheral). In the overwhelming majority of cases the papilloma is benign; it is classified as an "at-risk lesion" (B3) because it may, in a minority of cases, be associated with atypical or in-situ lesions.
What is done. According to the latest recommendations (French SENORIF 2025-2026 reference, Rubio EJSO 2024), papillomas are not systematically excised. What is mandatory is the core biopsy — a metal clip (e.g. Twirl) is placed at biopsy to mark the target. Then three options are discussed at MDT and with the patient: close radiological surveillance, vacuum-assisted excision (Mammotome), or surgical excision. If surgery is decided, pre-operative localisation is placed at the metal clip, either by wire localisation (hookwire) the day before or the morning of surgery, or by magnetic seed (Magseed, Localizer, Sirius) which can be placed several weeks in advance. → Read the detailed breast papilloma page.
What it is. A radial scar is a benign lesion that creates a characteristic star-shaped architectural distortion on mammogram. It can mimic a cancer on imaging. Biopsy is systematic. Its presence slightly increases the risk of breast cancer.
What is done. Surgical excision is generally recommended, even if the needle biopsy is benign — to exclude an associated in situ or invasive carcinoma that the biopsy may have missed.
What it is. A phyllodes tumour develops from the connective tissue of the breast, not from the glandular tissue. It can be benign, borderline or malignant. It often grows rapidly. It is different from a fibroadenoma — even if it can resemble one clinically.
What is done. Surgical excision with clear margins is necessary, regardless of the histological grade. The extent of excision depends on the size and grade. Unlike fibroadenoma, a simple enucleation is insufficient. Enhanced surveillance is organised after excision.
Have you received a result involving one of these lesions? I offer in-person consultations in Paris and teleconsultations for patients from a distance.
ADH, papilloma, radial scar, LCIS, early cancer, focus of microcalcifications — most of the lesions operated on today are non-palpable. To remove them, the surgeon needs a physical marker: hookwire (metal wire placed the day before or morning of surgery) or magnetic seed Magseed / Localizer / Sirius (placed several weeks in advance). A dedicated page details each technique, the workflow, and the specimen radiograph verification.
Most benign breast lesions do not require surgery. But certain situations — size, symptoms, rapid growth, patient's wish — may justify an intervention. Here is an overview of the most common lesions.
What it is. A fibroadenoma is a benign tumour made of glandular and connective tissue. It presents as a well-defined, firm, mobile nodule. It is the most common benign lesion in women under 35. The presence of a fibroadenoma does not increase the risk of breast cancer.
When to operate. Surgery is not systematic. The default approach is ultrasound monitoring (first check-up at 4 months then annual). Excision is offered in four situations: doubt on biopsy (phyllodes, atypia), significant growth over two successive check-ups, bothersome symptoms, or the informed choice of the patient. A percutaneous biopsy is always performed before any surgery to rule out a phyllodes tumour. → Read the detailed fibroadenoma page.
The procedure. Enucleation under local or general anaesthesia, usually as day surgery. The scar is discreet. No drain. Return to work in 1 to 5 days depending on the procedure.
What it is. Fibrocystic mastopathy is the most common benign breast condition. It combines zones of fibrous tissue, microcysts and sometimes glandular proliferation. It causes cyclical breast pain (mastodynia), generalised nodularity and breast sensitivity. It is a hormonal condition, related to oestrogen-progesterone imbalance.
Management. Surgery is not indicated for fibrocystic mastopathy itself. Management is medical (evening primrose oil, progestogens, reducing caffeine). If a suspicious zone appears, biopsy is performed to exclude an associated lesion.
What it is. A breast cyst is a fluid-filled sac. Simple cysts (thin walls, purely fluid content) are benign and very common — they require no intervention unless symptomatic. Complex cysts (thick walls, internal partitions, vegetations) require closer assessment and sometimes biopsy.
Management. A simple, asymptomatic cyst is simply monitored. A tense, painful cyst can be drained by aspiration under ultrasound guidance in a few minutes. Surgery is only indicated for complex cysts with suspicious characteristics on biopsy, or in case of recurrence after multiple aspirations.
What it is. A galactocele is a cyst filled with milk, occurring during or after breastfeeding. It presents as a smooth, painless palpable nodule. Ultrasound confirms the diagnosis.
Management. Most galactoceles resolve spontaneously. If symptomatic, aspiration under ultrasound guidance is effective. Surgery is rarely needed — only in case of infection or persistent very large galactocele.
Do you have a concern about a lesion? I offer in-person consultations in Paris and teleconsultations for patients from a distance.
Your mammogram or ultrasound report includes an ACR (or BI-RADS) classification — a number from 1 to 6 that standardises how suspicious a finding is. Here is what each category means in practice.
The examination shows no suspicious abnormality. Routine screening is continued according to the recommended schedule (mammogram every 2 years from age 50 as part of organised screening, or annually if high risk).
A clearly benign abnormality is found (simple cyst, calcified fibroadenoma, benign lymph node). No biopsy or additional workup is needed. Screening continues normally.
A lesion with a low probability of malignancy (less than 2%). Short-term surveillance (mammogram or ultrasound at 6 months, then annually for 2 to 3 years) is recommended to verify stability. Biopsy is not systematic but may be proposed depending on the context (patient anxiety, imaging characteristics, family history). If the lesion is stable for 2 to 3 years, it is reclassified as ACR 2.
A lesion with intermediate probability of malignancy (2% to 95%). Biopsy is recommended. ACR 4 is subdivided into 4A (low suspicion), 4B (intermediate) and 4C (high suspicion). The result of the biopsy determines subsequent management.
A lesion with a very high probability of malignancy (greater than 95%). Biopsy must be performed urgently to confirm the diagnosis before planning treatment. An ACR 5 does not mean that surgery will necessarily follow immediately — the biopsy first establishes the exact diagnosis.
ACR 6 is assigned when a lesion has already been confirmed as cancer by a prior biopsy. This classification is used for imaging performed during the assessment or treatment of a known cancer (to assess treatment response for example).
Does your radiology report seem difficult to understand? I offer in-person consultations in Paris and teleconsultations for patients from a distance.
The pathology report analyses the nature of the cells sampled during biopsy. Its terms can be disconcerting. Here is what the most common terms mean in practice.
The SBR grade (Scarff-Bloom-Richardson, or Elston-Ellis in English) assesses the degree of differentiation of cancer cells. Grade I: cells resemble normal cells — low aggressiveness. Grade II: intermediate. Grade III: cells are very different from normal cells — higher aggressiveness, often requiring chemotherapy. This grade is combined with other factors (Ki67, hormone receptors) to guide treatment decisions.
Ki67 is a protein present in cells that are actively dividing. A high Ki67 (generally above 20%) indicates a rapidly proliferating tumour. This is an important factor in the decision to offer chemotherapy for hormone-sensitive cancers. Combined with grade and receptor status, it contributes to the overall profile of the tumour.
ER (oestrogen receptors) and PR (progesterone receptors) are proteins present on tumour cells. A positive result means the tumour feeds on hormones — it is therefore sensitive to hormone therapy (tamoxifen, aromatase inhibitors). The percentage and intensity of positivity guide treatment decisions. The majority of breast cancers are hormone receptor positive.
HER2 (Human Epidermal growth factor Receptor 2) is a receptor involved in cell growth. HER2 overexpression (3+ on immunohistochemistry, or amplified on FISH) makes the tumour sensitive to anti-HER2 targeted therapies (trastuzumab = Herceptin, pertuzumab). HER2-positive cancers account for approximately 15% of cases. HER2 2+ requires confirmation by FISH analysis.
Have you received a biopsy result and would like an opinion? I offer in-person consultations in Paris and teleconsultations for patients from a distance.
Come with your questions, your results, your concerns. We take the time to discuss everything together.
Dr Zeitoun practises as a private specialist (Sector 2). French national health insurance reimburses on the basis of the standard rate. Complementary health insurance may cover additional fees.