Treatment of Benign Phyllodes Tumour of Breast
Phyllodes tumours (PT) are uncommon biphasic breast neoplasms with both stromal and epithelial components. They are classified as benign, borderline, or malignant — with benign PT representing the majority of cases. Accurate histological subtyping directly shapes the surgical strategy.
Clinical scenario
This protocol addresses patients with a confirmed benign phyllodes tumour of the breast. Management is primarily surgical; the histological classification as benign is the key determinant of the operative goals and approach.
Surgical goal
The primary objective is complete surgical excision with the capsule intact and uninvolved (negative) margins. Achieving clear margins at the time of initial surgery is the central endpoint of management.
Treatment approach (partial overview)
Breast-conserving surgery is the recommended approach when adequate surgical margins can be achieved. In situations where straightforward breast-conserving surgery is insufficient, the pathway involves multidisciplinary oncoplastic discussion and consideration of further surgical options — including reconstruction considerations.
The complete decision algorithm, patient selection criteria, and reconstruction pathway are detailed in the full structured protocol below.
References
DOI: 10.1093/bjs/znaf152
- PT are biphasic with both stromal and epithelial components and are classified into three groups with the following proportions: benign, 50–70%; borderline, 12–26%; and malignant, 20–30%.
- For all PT, BCS can be offered if adequate surgical excision margins can be achieved (evidence/grade IV/B).
- For benign PT, aim for complete excision with the capsule intact (evidence/grade IV/A).
- If complex oncoplastic BCS techniques are required, or, a mastectomy is required to achieve clear margins, this should be discussed at a local oncoplastic MDT meeting with plastic and breast surgeons where available (evidence/grade V/B).
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