Papillary lesion of the lactiferous ducts. Surgical excision recommended for systematic histological analysis due to risk of atypia.
Dr Zeitoun reviews your complete file at your first consultation: imaging, biopsy, family history. Following the most recent French recommendations, we choose together the best option — surveillance, removal by vacuum-assisted excision without surgery, or surgery — and make sure the strategy fits your life plans.
Paris 8th practice · Clinique Hartmann Neuilly · Sector 2 non-OPTAM
A breast papilloma (or intraductal papilloma) is a small benign outgrowth that develops inside one of the milk ducts of the breast — these are the thin channels that carry milk to the nipple. There are two types: the central papilloma, which develops in a large duct just behind the nipple (and often causes a nipple discharge), and the peripheral papilloma, located deeper in the breast, which usually goes unnoticed until an imaging examination. The papilloma is benign in the vast majority of cases; more rarely, it may contain abnormal cells or the very beginning of a cancer.
Why we call it an "at-risk lesion": a papilloma does not turn into cancer. It is called "at-risk" (classification B3 — uncertain malignant potential) because, in a minority of cases, we discover during its removal that it also contained abnormal cells or the beginning of a cancer. This B3 category groups other lesions of the same family: atypical ductal hyperplasia (ADH), atypical lobular hyperplasia, classic lobular carcinoma in situ and radial scar.
The largest studies show that 10 to 30 % of papillomas diagnosed on biopsy actually contain a cancer (often an early non-invasive cancer) that is only revealed when the lesion is fully removed. This data historically justified always removing the lesion. The most recent recommendations (SENORIF 2025-2026, Rubio EJSO 2024, Elfgen Virchow Archiv 2023) now propose a more nuanced approach: depending on the situation, one can also offer vacuum-assisted excision (removing the lesion through the skin, without surgery) or simple surveillance, under specific conditions.
The central papilloma is located in the large ducts just behind the nipple. It typically presents with a spontaneous nipple discharge — sometimes clear, sometimes tinged with blood — always coming from a single opening: this is the most typical sign. The peripheral papilloma, on the other hand, is located further from the nipple, usually gives no symptoms, and is discovered during a screening mammography or a routine ultrasound. The strategy is different depending on the location: a central papilloma that leaks and is bothersome on a daily basis will more readily be removed surgically, using a technique called microdochectomy (pyramidal duct excision).
A papilloma is simply a small benign outgrowth that forms on the inner wall of a milk duct. There is no single cause: several factors contribute to its appearance.
Central papilloma is more common in women aged 40 to 60. Peripheral papilloma may be diagnosed at any age, often on routine imaging.
Breast tissue responds variably to hormonal stimulation. Peripheral papillomas may be multiple (papillomatosis), in one or both breasts, reflecting an individual tendency.
Important: the presence of a papilloma, as an at-risk lesion (B3), justifies appropriate radiological follow-up even after excision. The risk of later developing a breast lesion is increased, particularly with multiple papillomatosis or associated atypia.
Source: SENORIF 2025-2026 · SFSPM
Peripheral papilloma most often gives no symptoms: it is found on ultrasound or screening mammography. Central papilloma, on the other hand, can announce itself by a very typical sign: a spontaneous nipple discharge.
This is the most typical sign of central papilloma: a spontaneous discharge (appearing on its own, without pressing), on one side only, from a single opening of the nipple, often tinged with blood or pink. It calls for a prompt examination.
Most papillomas, especially peripheral ones, are picked up on ultrasound or screening mammography. They usually cannot be felt by hand.
More rarely, the papilloma can be felt to the touch, as a small lump just behind the nipple, especially for larger central papillomas.
What should prompt a prompt consultation: a discharge that appears on its own, on one side, from a single opening of the nipple (especially if red or pink) — or a new lump in the breast. On the contrary: a discharge that only appears when you press, on both sides, from several openings, and milky or greenish in colour, is very rarely a sign of serious disease.
Source: SFSPM · HAS
The diagnosis is made in several steps: clinical examination, targeted breast imaging (ultrasound and/or mammography), then a systematic core biopsy (a small fragment taken with a needle for microscopic analysis). The core biopsy is essential before any decision — this is the basic rule.
Examination of both breasts and the lymph node areas (under the arms). Check of the discharge if any (from one side or both, from a single opening or several, its colour). Inspection of the nipple.
Ultrasound and mammography according to your age. Galactography or breast MRI in certain situations (isolated discharge without visible lesion on US/mammo). We routinely place a small metal clip (the Twirl) at the time of biopsy: it marks the target in case the lesion is completely removed by the sampling.
Needle sampling at the radiology clinic, mandatory before any treatment decision. It confirms it really is a papilloma, looks for any abnormal cells associated, and rules out other similar-looking lesions.
A core biopsy is not always definitive: the doctors who analyse the tissue under the microscope (anatomopathologists) may sometimes interpret this kind of lesion differently. In case of doubt, Dr Zeitoun may request a second opinion from a SEIN-PATH expert group or present your case at a multidisciplinary team meeting (MDT). The diagnosis is definitively confirmed when the lesion is removed and analysed in its entirety.
Source: SENORIF 2025-2026 · HAS · SFSPM
Good news: according to the recent French recommendations (SENORIF 2025-2026), papillomas are no longer routinely excised. What is mandatory is the core biopsy. Then three options are possible, discussed at multidisciplinary team meeting (MDT) and then with you: imaging surveillance, vacuum-assisted excision (removal through the skin without surgery), or surgery. The choice is made case-by-case.
Possible if several conditions are met: imaging and biopsy are consistent, the lesion is under 15 mm, there are no more than one or two foci, no symptoms, no significant personal or family history, and you agree to close follow-up.
Alternative to surgery: the lesion is removed through the skin, with a needle (Mammotome vacuum-assisted system), at the radiology clinic. Under ultrasound or mammography guidance. Indicated if the lesion is accessible, without associated abnormal cells, and not too close to the nipple.
Indicated if there are associated abnormal cells, if the lesion is too large for a vacuum excision, if it is too close to the nipple (central papilloma), if there is a blood-tinged discharge, or in the context of an ART plan.
During the initial core or vacuum biopsy, the radiologist places a small metal clip (Twirl type) at the exact spot where the sampling was done. This clip plays two roles: marking the target in case the lesion disappears after the sampling (which sometimes happens with larger vacuum biopsies), and serving as a reference point if surgery is later decided. This clip is completely neutral for the body, does not interfere with MRI or mammography, and can stay in place without issue.
A papilloma is almost always invisible to the touch. If surgery is decided, a pre-operative localisation is essential to guide the surgeon to the lesion. This localisation is placed at the metal clip already in place. Two techniques are possible — the choice is made with you and the radiologist, depending on what is most practical and comfortable.
A thin metal wire with one end anchored close to the biopsy clip, the other exiting the skin. Placed under ultrasound guidance, the day before or the morning of surgery. Classic technique, still widely used — reliable and inexpensive.
A small magnetic seed (Magseed, Localizer or Sirius) placed at the metal clip. Detected during surgery by a dedicated probe. Major advantage: it can be placed several weeks before surgery, which simplifies the schedule — you do not need to arrive fasting with a wire exiting the skin.
The aim of surgery: to remove in one single block the localisation marker (hookwire or magnetic seed), the biopsy clip, and the surrounding lesion. A specimen X-ray is performed at the end of surgery to check that everything has been removed. The procedure is performed in theatre, as day surgery (home the same day), most often under general anaesthesia. The scar is often placed around the areola, which makes it very discreet. The entire specimen is analysed under the microscope.
Further reading: pre-operative localisation deserves its own page — technique, workflow, practical differences between hookwire and magnetic seed (Magseed, Localizer, Sirius), specimen X-ray. Read the full page on pre-operative localisation →
When a nipple discharge is found during surgery, we use a technique called microdochectomy (because the area removed is pyramid-shaped). It consists of identifying the dilated duct causing the discharge, then, through an incision around the areola, removing this duct in one single block with the lesion it contains. Everything is then analysed under the microscope to identify the exact cause and look for any associated abnormal cells.
Mastectomy (removing the whole breast) for multiple diffuse papillomas remains exceptional. When papillomas are very widespread, we usually prefer a two-step surgery with a wide lumpectomy — when possible — after one or two biopsies have helped map out the extent. As a general rule, we do not remove a breast for a benign lesion, except in exceptional situations to be discussed depending on your age, your personal and family history, and the possible existence of a genetic predisposition (particularly BRCA mutations).
Source: SENORIF 2025-2026 · Rubio EJSO 2024 · Elfgen Virchow Archiv 2023
Recovery after papilloma excision is usually straightforward. The procedure is performed as day surgery, with return home on the same day.
Moderate during the first 48 hours, well relieved by simple analgesics (paracetamol).
3 to 7 days for sedentary work. 10 to 15 days for physical work.
Light sport at 2-3 weeks. Activities with arms above the head to be deferred 3-4 weeks.
Peri-areolar scar in place over 6 to 12 months. Generally favourable evolution.
Report available in 2 to 3 weeks. Dedicated follow-up consultation to organise ongoing follow-up.
Key principle for papilloma: a papilloma is never re-excised, even if margins are involved or atypia is found on the specimen (SENORIF 2025). Only the discovery of an associated cancer changes management.
Source: SENORIF 2025-2026 · SFSPM
Papilloma excision is a very safe procedure, with a very low rate of complications. Dr Zeitoun details each risk during the pre-operative consultation — this information is part of shared decision-making and is systematic before any surgery.
The most common post-operative risk. Usually moderate, it resolves spontaneously within a few days. A large haematoma rarely requires re-operation.
Very low risk (< 1 %) thanks to strict theatre asepsis. Warning signs (redness, discharge, fever) should prompt consultation without delay.
Keloid or hypertrophic scar possible depending on individual tendency. Scar massage from 4 weeks onwards optimises the result.
Transient change in nipple sensation is possible after microdochectomy, due to the proximity of the incision to nerve endings. Usual recovery within a few months.
10 to 30 % of papillary lesions reveal cancer on surgical pathology. In this case, management is adapted according to type and extent — an anticipated and planned situation.
Microdochectomy removes one galactophoric duct. Breast-feeding remains possible after surgery — the other ducts of the breast function normally.
Source: SENORIF 2025-2026 · SFSPM · CNGOF
Dr Zeitoun reviews your biopsy and imaging, presents your file at the multidisciplinary team meeting (MDT), and proposes the most suitable strategy — surveillance, vacuum-assisted excision or surgery — following the French SENORIF 2025-2026 reference.
Paris 8th practice · Clinique Hartmann Neuilly · Sector 2 non-OPTAM · Second opinions on file welcome
The answers below are based on the SENORIF 2025-2026 reference, CNGOF and SFSPM recommendations, and daily clinical practice.
A papilloma itself does not degenerate into cancer. It is called an "at-risk lesion" because, in a minority of cases, it may be associated with atypical cells or in-situ cancer. Published series report that 10 to 30 % of papillomas diagnosed on biopsy reveal cancer on final excision. This is why core biopsy is systematic and the strategy is discussed at MDT.
No. According to the latest recommendations (SENORIF 2025-2026, Rubio EJSO 2024, Elfgen Virchow Archiv 2023), papillomas are not systematically excised. What is mandatory is the core biopsy. Then three options are possible, discussed at MDT and with the patient: radiological surveillance, vacuum-assisted excision, or surgical excision.
Vacuum-assisted excision (Mammotome or other vacuum-assisted systems) is a non-surgical alternative to lumpectomy. It allows removal of the entire lesion percutaneously, under ultrasound or stereotactic guidance, in the radiology clinic. It is a validated option in SENORIF under specific conditions: accessible size, no atypia, radio-histological concordance, patient accepting close follow-up.
A papilloma is almost always a non-palpable lesion. A metal clip (e.g. Twirl) was placed at the initial core biopsy — it marks the target and serves as a reference point if the lesion disappears after sampling. When surgical excision is decided, pre-operative localisation is placed at this metal clip, either by wire localisation (hookwire) — a thin wire exiting the skin, placed the day before or the morning of surgery — or by magnetic seed (Magseed, Localizer or Sirius), which can be placed several weeks before surgery. The surgical objective is to remove en-bloc the hookwire or magnetic seed, the biopsy metal clip and the associated lesion. Day surgery in theatre, usually peri-areolar scar.
Microdochectomy is the reference technique when bloody nipple discharge is found intra-operatively. It consists in isolating the dilated galactophoric duct responsible for the discharge, then excising en-bloc this duct with the clipped lesion through a peri-areolar incision. Histopathology looks for the causative lesion and any associated lesions.
The 15 mm threshold is acknowledged by the SENORIF 2025-2026 reference and European guidelines (Rubio EJSO 2024) as a criterion for discussion: beyond this size, vacuum-assisted excision is technically more difficult and surgical excision is often preferred. This is not a rigid cut-off: the decision is always made case-by-case, at MDT, integrating age, history, symptoms, proximity to the nipple-areolar complex and the patient\u0027s choice.
Mastectomy for diffuse papillomatosis remains exceptional. The usual approach is a two-step surgery with a wide lumpectomy — when feasible — after one or two core or vacuum-assisted biopsies confirm the extent. As a general rule, mastectomy is not performed for benign lesions, except in exceptional cases adapted to age, history, and possible genetic predisposition (particularly BRCA mutations).
Yes. In the context of an assisted reproductive technology (ART/IVF) project, most teams favour surgical excision rather than surveillance or vacuum-assisted excision, in order to obtain rapid and complete histological diagnosis without delaying the ART pathway.
No. A papilloma is never re-excised — even if the excision is not in sano (involved margins) or if atypia is found on the surgical specimen (SENORIF 2025-2026). This is an important rule: unlike cancer, where clear margins are mandatory, papilloma benefits from a conservative strategy confirmed by the latest recommendations. Only the discovery of an associated cancer on histopathology changes management — it is then adapted at MDT.
Dr Zeitoun practises in sector 2 non-OPTAM: additional fees apply. Excision is covered by French Assurance Maladie at the contractual rate. A personalised quote is systematically provided after the consultation. Out-of-pocket expenses depend on your complementary health insurance.
This page relies on the French SENORIF 2025-2026 reference, recommendations from French and international medical societies, and on recent medical literature indexed in PubMed.
Last reviewed: 22 April 2026 · Next scheduled update: October 2026.
Dr Zeitoun receives you for a thorough examination, a full review of your file and the development of a personalised strategy — surveillance, vacuum-assisted excision or surgery. Paris 8th practice or Clinique Hartmann Neuilly. Second opinions on file are welcome.