Palpable PASH- To remove or not to remove?

km2214

I have PASH diagnosed on ultrasound guided core need biopsy in August (first felt the lump in May, 5 samples, smallest needles available, I think 15?), following original ultrasound (palpable: 1.5x0.8x1.7cm), my pathology report noted: "benign breast parenchyma with fibrocystic changes including columnar cell change, pseudoangiomatous stromal hyperpasia, and stromal fibrosis." My PASH is continuing to grow and beginning to see the bump through my skin, it has been a bit of a confusing journey; the original letter just said do a mamogram at 40, but after meeting with a breast surgeon she called for ultrasounds every six months on the basis that it is 1. not entirely palpable, 2. I have healing issues, 3. She knows I will follow up if it changes (which I have an appointment to do, because it is growing and began to hurt about 1.5 months ago.) My question is, would you remove it? I am 28 and a few other autoimmune diseases that affect my ability to heal. Thank you for all the support and kindness.

MandyP

I had mine removed in May (I'm 48) and it's back already.  SO frustrated.  It's bigger than ever and the lump I feel (close to my armpit) is about the size of a peach pit.  The only reason I had mine removed is because I've had other excisional biopsies and my breasts are beyond "busy".  Surgeon told me PASH is commonly seen in younger (often pregnant) women.  Way to go for me at 48.  AGH!  

I don't know what to tell you, from what I've read it can return and mine already has (and is growing).

abs44

I have PASH diagnosed last December through core needle biopsy. It was painless at first (but palpable). I saw a general surgeon and he suggested I do nothing and come back for another ultrasound and biopsy in 6 months. About 4 months in I noticed it growing and getting painful so I sought a second opinion with the Director of the Breast Center at a prestigious research hospital in my state. That doctor did not do any further tests, confirmed the PASH felt like it was growing, and told me surgery was not an option and that nobody operates on PASH anymore. I asked her what would happen if my breast just kept getting larger and I was very lopsided. She said that if that bothered me she could refer me to a plastic surgeon for a mastectomy and reconstruction. 

I saw the general surgeon again at the 6 month mark and he did not do another ultrasound or biopsy and told me not to worry about it. In regards to surgery, he said that so much tissue would need to be removed that I would be very deformed afterward. 

I wish they would have just removed it when it was a small lump I don't know what I will do. The pain continually increases but I don't want to have major surgery and lose a breast at 25. If I were you, I would remove it if your doctor says the healing problem will not be a significant issue. I imagine it would be easier to heal after a lumpectomy than it would after a mastectomy, god forbid it come to that. 

km2214

Dear Mandy and ABS, thank you so much for the kind replies-- it means so much, and is so helpful. I am so sorry that you have to go through this, but I feel very thankful sharing your experience. 

ABS, I am really similar:

May '14 noticed it

August '14 went to doctor, 15x8x17mm on ultrasound, core needle shows "benign breast parenchyma with fibrocystic changes including columnar cell change, pseudoangiomatous stromal hyperpasia, and stromal fibrosis." BI-RADs: 4A

September '14 began to hurt

October '14 see breast surgeon, second ultra sounds shows that it 23x12x23mm; BI-RADs: 4A; now surgery scheduled for November 25th for "Extensional Biopsy." I am going to have a plastic surgeon join my breast surgeon; they say there may be a bit of a cosmetic deformity. I am going to get a second opinion on Friday too. 

ABS I hope that you can get some more opinions too, I am really sorry you are in pain; Mandy, I am so sorry yours has returned. 

kdinkle1

Hi there, as Mandy said it can reoccur or you can get multiple ones like I did. Sometimes however you might just get the one. My breast centre does not remove them individually as they will remove too much tissue and also because they can reoccur or you could end up getting more. After a few years of pash issues i opted for a double mastectomy with reconstruction and am very happy that I did. I'm 37 and my husband (who is brutally honest!) Says that they look good. Better than i ever thought they would too. Its vital you have a reputable breast surgeon if you were to go down the mastectomy/reconstruction route. Also ensure its the right decision for you. Its not an easy decision and certainly no walk in the park but if it was to come to that there are many positives x

Molly12

hi MandyP

I was diagnosed with Pash last December, had lump removed this past March. It's Christmas again the lumps are back. I go on the 29th of this month to get another biopsy. I have multiple cyst (hopefully just pop those) one cyst at 9cm and one at 3cm. The last lump that was removed was 5 cm. I'm not sure if this is going to be a routine trip to surgery every so many months. This is getting frustrating!!!

Patty252555140415

I was dxd with IDC in 2011, lumpectomy chemo rads arimidex recently moved from NY to AZ going to breast center in Las Vegas NV. Once sent me for routine MRI showed enhancement had

MRI guided biopsy results were PASH and radial scar was wondering if anyone has heard of this after cancer

MandyP

Molly12, let me know how your biopsy went. I still haven't gone back to my surgeon even tho he told me in September when he saw me last to let him know if it wasn't going away (he was thinking scar tissue from the surgery in May). I'm an RN and work with him at the hospital and I suppose I should let him know. I'm a pretty thin gal with smaller breasts (B cup on a good day) and you can see this lump when I move my arm a certain way. Still about the size of a peach pit, doesn't move, feels very solid. I do see him in early March after my annual mammo and ultrasound but he's going to be mad if I at least don't tell him before. I just know it's PASH again and not scar tissue. SAME exact area, it's like he missed the lump I went to surgery for but my path report showed some mass.

Anyway, please let me know how you're doing Molly.

614

I thought that I was the only person with "busy breasts"!

Bren64

I was just diagnosed with Pash though out my breasts and my doctor said most people have them removed. Since I have several they recommend a bi-lateral. I'm considering it but concerned about the recovery time and scarring. All the types of reconstructive surgery is confusing

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km2214

Oh gosh, I am so sorry-- I was misdiagnosed with pash on core needle-- it was actually diabetic mastopathy. I would get a few opinions. I ended up having a very large exceptional biopsy because tissue grew after core, I still have huge pain in my chest-- but I think there is a good case to leave pash and make sure they really double check that they diagnosed correctly. I am so sorry, good luck. 

Abby99

Hi

I am 38 amd have had PASH since about 27.

I have had 3 surgeries and approx 10 PASH masses removed ranging from 3 to 7 cm.

Every single time I had the surgery, PASH was back within 6 months so now I have 2 choices. Yearly ultrasounds or mastectomy. So far, I have chosen to watch, but I too am starting to get antsy. Margins are becoming harder to detect etc. All doctors who have seen me all said they have never seen such a bad case of PASH. I am literally full of it! This probably does not help but wanted to let you know my experience

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Dear Abby99, Thanks for sharing your story here and welcome to the community. We hope that you will stay connected and keep us posted on your situation. The Mods

17215

I have PASH too. Five lesions. Dense breasts. A few areas have been recommended to be removed. After about 3 years of monitoring I have a surgery date to have a mastectomy. I don't like that no one can tell me I am fine. I don't want to live at the breast center either. I can see on my last radiologist face how complicated the ultrasounds are and she nicely told me my breasts are a nightmare. As much as I want this to be done, the surgery is scary. Continual monitoring and wondering if the doctors can keep track or even find a problem is worrisome but the surgery is scary too. I am wondering what you have don

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Hi 17215, welcome to Breastcancer.org. Sorry you find yourself in this situation, but glad you've found us!

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rissaandcrew

17215,

Last week I had an excision biopsy where they took a golf ball sized mass. Got the call last night that it is PASH. Feeling overwhelmed. They did not get clean margins and don't know how to proceed. Likely more surgery. It sounds like it will probably come back either way. Growth was pretty fast in the mass they removed and it was painful. It is good to know there are others out there facing the same thing. It sounds like PASH is not very common or well understood. If you have any good info or resources I would love be to hear of them. Dr. Google has not been very helpful and my surgeon is presenting my case to the hospitals tumor board next week for suggestions. I have not seen my path report yet but he made it sound like my case is complicated. I'm not looking forward to a future of scans and call backs that require biopsy. I would rather just have BMX and be done. He made it sound like I am now in a high risk group for BC in the future. Not sure why that is. The info I have found on PASH does not link itto malignancies.