What is the first treatment for Paget disease of the breast?

Paget disease affects the nipple and areola and can occur with an underlying breast tumour. Examination, mammography or other imaging, and a biopsy help define the diagnosis and extent. A lumpectomy removes the nipple-areola area and a margin of surrounding tissue while preserving much of the breast. A mastectomy removes the breast and may be advised when disease is widespread, when breast-conserving surgery would not remove it adequately, or when there are other findings that change the operation.

Discuss the imaging and biopsy report with a breast surgeon. Ask where the disease is located, whether breast-conserving surgery is suitable, and whether additional treatment is expected after the operation. Talk through reconstruction, nipple appearance, recovery, and how the final laboratory report could affect the next decision.

Before treatment, seek prompt assessment for a new nipple wound, bloody discharge, a rapidly changing breast area or a new lump. After surgery, contact the care team for fever, spreading redness, increasing swelling, wound opening, uncontrolled pain or sudden breathlessness.

Is there an underlying tumour on my imaging or biopsy? Could lumpectomy remove all affected tissue? What would make mastectomy the safer choice? Will I need further treatment after surgery?