How effective is lumpectomy for Paget disease of the breast?

Paget disease affects the nipple and areola and can occur with ductal carcinoma in situ or an invasive breast tumour deeper in the breast. Imaging and biopsy help show whether there is an associated tumour and how widely the disease extends.

A breast-conserving operation may remove the nipple-areola area and the associated tissue. The pathology report checks the margins and identifies tumour features that influence radiation, lymph-node assessment, hormone treatment, chemotherapy or targeted treatment. The operation’s suitability is therefore based on the full breast assessment, not the nipple appearance alone.

Ask whether breast imaging has shown disease away from the nipple, how much tissue will be removed and what reconstruction or reshaping options are available. Confirm whether lymph-node sampling is planned.

Discuss the likely pathology timeline, the possibility of further surgery if margins are involved and whether radiation is expected after healing. Mention any nipple discharge, crusting, bleeding, prior breast procedures or medicines that affect bleeding.

Contact the surgical team for fever, increasing redness, worsening swelling, escalating pain, pus-like drainage, persistent bleeding or a wound that opens. Seek urgent help for sudden chest pain, severe breathlessness, fainting or heavy bleeding.

Is there an underlying tumour with my Paget disease? Can it be removed with a clear margin while preserving the breast? Will I need lymph-node assessment, radiation or medicines after surgery? What change to the nipple area should I expect?