Surgical Options for Atypical Ductal Hyperplasia: What to Expect

I would like to inquire about surgical issues related to atypical ductal hyperplasia?

Hello Dr.
Lee: I have a few questions regarding my recent experience.
I previously underwent a core needle biopsy for my breast, and the report indicated atypical ductal hyperplasia.
The doctor recommended surgery before it worsens.
However, I have been researching and couldn't find articles specifically discussing surgical options for atypical ductal hyperplasia, so I hope it's not too presumptuous to ask you a few questions:
1.
My lesion is approximately 1.7 cm, located at the 7 o'clock position in my right breast, about 4 cm from the nipple.
The doctor mentioned that to be cautious, they would remove an additional 1 cm on each side, which may slightly involve the pectoralis major muscle.
Will this type of surgery affect the appearance of my breast, such as causing sagging?
2.
For this type of surgery, besides traditional surgical methods, is there a possibility of performing a minimally invasive procedure?
I apologize for the numerous questions, and I appreciate your help.
Thank you!

Gioia, 30~39 year old female. Ask Date: 2015/11/16

Dr. Li Zhonghuai reply Surgery

Hello! The report from the breast core needle biopsy indicates atypical ductal hyperplasia, which does not necessarily mean that the entire 1.7 cm tumor is benign.
It is recommended to perform a complete excision of the tumor.
If only the tumor is removed (i.e., breast-conserving surgery), the cavity left after surgery will be filled with tissue fluid, and it generally will not affect the appearance of the breast.
Recent medical journals have shown that a margin of 0.1 cm from the tumor is sufficient.
As for minimally invasive surgical instruments, they require an incision in the axilla, which differs from the traditional approach of making an incision directly over the tumor.
If the incision can be made at the edge of the areola, the scar may be less noticeable, although it may be technically more challenging.
It is advisable to consult with your physician for an evaluation.
Therefore, whether to opt for out-of-pocket expenses for minimally invasive surgery is a matter of personal preference.
Wishing you a speedy recovery! Changhua Hospital cares about you!

Reply Date: 2015/11/16

More Info

When it comes to managing atypical ductal hyperplasia (ADH), the surgical options and expectations can vary based on individual circumstances. ADH is a condition characterized by the presence of abnormal cells in the breast ducts, which may increase the risk of developing breast cancer in the future. Given your situation, where a core needle biopsy has confirmed ADH, it is understandable that you have questions regarding the recommended surgical intervention.

1. Surgical Procedure and Aesthetic Outcomes: The surgery your doctor is recommending involves excising the area of abnormal tissue along with a margin of healthy tissue. In your case, the planned excision of approximately 1.7 cm of tissue, plus an additional 1 cm on either side, is intended to ensure that all abnormal cells are removed. This approach is often referred to as a wide local excision or lumpectomy. While this procedure is generally effective in removing the abnormal tissue, it can lead to changes in the breast's appearance. The extent of these changes can depend on several factors, including the size of the excised tissue, your breast size, and the surgical technique used. In some cases, patients may experience a slight indentation or asymmetry, but many find that the overall appearance of the breast remains acceptable. If you have concerns about potential changes, discussing these with your surgeon can help clarify what to expect and explore options for cosmetic enhancement if necessary.

2. Minimally Invasive Surgical Options: Regarding the possibility of minimally invasive techniques, there are advancements in breast surgery that may allow for less invasive options, such as vacuum-assisted excision or other techniques that can remove tissue with smaller incisions. However, the suitability of these methods depends on the specifics of your case, including the size and location of the ADH. Traditional surgical excision remains the gold standard for ensuring complete removal of the abnormal tissue and is often recommended for cases like yours. It is essential to have a thorough discussion with your surgeon about the potential for minimally invasive options, as well as the risks and benefits associated with them.

In summary, while surgery for atypical ductal hyperplasia is a proactive step to reduce the risk of breast cancer, it is essential to have open communication with your healthcare provider about your concerns regarding aesthetics and the surgical approach. Your surgeon can provide tailored advice based on your specific situation, including the potential for minimally invasive techniques and what you can expect in terms of recovery and breast appearance post-surgery. Remember, the goal of the surgery is not only to remove the abnormal cells but also to ensure your long-term health and peace of mind.

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