Not every breast condition requires treatment. Many benign breast findings — including small fibroadenomas, simple cysts, areas of fibrocystic change, and certain high-risk lesions identified on biopsy — are best managed with active monitoring rather than immediate surgery. The goal of surveillance is to confirm stability over time, detect any change that warrants further assessment, and provide the patient with confidence that their breast health is being appropriately managed.

At Breast & Surgical Oncology at The Poche Centre, benign breast assessment and surveillance planning is mostly managed by our breast physician who specialises in this area.  We provide clear, evidence-based guidance on which conditions require monitoring, what that monitoring involves, how long it should continue, and when a change in the findings warrants a change in approach.  If you subsequently need surgery for a benign problem then you will be immediately seen by one of our specialist surgeons.

Conditions Commonly Managed with Surveillance

Fibroadenomas — small, stable fibroadenomas in younger women can be safely monitored with periodic ultrasound rather than removed. Surveillance typically involves ultrasound every six to twelve months for one to two years to confirm stability, after which less frequent review is appropriate if no growth is demonstrated. A fibroadenoma that grows, becomes symptomatic, or reaches a size of 3 to 4 cm or more is generally recommended for excision.

Simple breast cysts — simple cysts with no concerning features on ultrasound are benign and do not require treatment unless they are causing symptoms. Periodic imaging review confirms that the cyst remains simple in character and has not developed internal complexity that would warrant further assessment. Symptomatic cysts can be aspirated for immediate relief.

Fibrocystic change and nodularity — generalised lumpiness of the breast tissue related to hormonal change is extremely common and benign. Where clinical examination and imaging confirm that the nodularity is diffuse and consistent with fibrocystic change rather than a discrete lesion, reassurance and breast awareness rather than ongoing formal surveillance is appropriate for most women.

Atypical ductal hyperplasia (ADH) — ADH identified on core biopsy is a high-risk lesion associated with a four to five-fold elevated lifetime risk of breast cancer compared to the general population. Surgical excision of the ADH lesion is generally recommended to exclude an associated higher-grade lesion adjacent to the biopsy site. Following excision, ongoing surveillance with annual mammography and ultrasound (or contrast imaging for dense breasts) is advised, and chemoprevention with tamoxifen or raloxifene may be discussed as a risk-reduction option.

Atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) — these lobular high-risk lesions are associated with an elevated lifetime breast cancer risk of approximately two to four-fold for ALH and eight to ten-fold for LCIS compared to average risk. They are markers of generalised increased risk throughout both breasts rather than precursors at a specific site. Management involves enhanced surveillance, risk factor modification, and discussion of chemoprevention. Surgical excision of the specific biopsy site is not always required and is guided by the clinical and imaging context.

Papillomas — a solitary intraductal papilloma identified on core biopsy may require surgical or vacuum-assisted biopsy (VAB) excision to exclude atypia or malignancy that may not be represented in the core biopsy sample. Multiple papillomas throughout the duct system are associated with a modestly elevated breast cancer risk and warrant ongoing surveillance after excision.

Radial scars — radial scars or complex sclerosing lesions identified on imaging or core biopsy are usually recommended for surgical excision due to the possibility of associated atypia or malignancy that may not be represented in the biopsy sample. After excision with a benign result, ongoing surveillance is guided by the overall clinical and risk context.

What a Surveillance Plan Looks Like

A personalised surveillance plan is developed at your consultation based on the specific benign condition identified, your overall breast cancer risk level, your age and menopausal status, and your breast density.

The plan will specify the type and frequency of imaging recommended (mammogram, ultrasound, MRI, or a combination), the interval between reviews, whether clinical breast examination by a specialist is part of the schedule, the duration of the surveillance program, and the specific changes or findings that would trigger re-assessment or a change in management.

Surveillance plans are documented and communicated to your GP so that the monitoring schedule is shared and can be followed consistently over time.

When Surveillance Moves to Treatment

Active surveillance is not indefinite and passive. A change in a monitored lesion — growth of a fibroadenoma, development of complexity in a previously simple cyst, a new area of concern on imaging, or a change on clinical examination — is an active trigger for reassessment. Your surveillance plan will clearly specify what constitutes a significant change and what the recommended response is.

If at any point during surveillance you notice a new breast change between scheduled reviews, you should seek assessment promptly rather than waiting for the next scheduled appointment.

Booking an Appointment

A GP referral is required for a specialist benign breast assessment consultation. If you have a known benign breast condition and are seeking specialist guidance on management and monitoring, or if you have received a biopsy result showing a high-risk lesion and want specialist advice on next steps, we welcome the opportunity to see you.

This page is intended as a general guide only and does not replace personalised medical advice. Surveillance decisions for benign breast conditions are highly individual and should always be discussed with your specialist.