Bi-rads 4 but unsure why

I'm 40 years old and I have had fibrocystic breast since I was at least 20 years old so every month there is some kind of lump in my breast.

In 2010 I had a round hard lump I couldn't move directly under my left nipple and had it removed. It was a b9 tumor that had a cyst growing in it. I wouldn't have had that removed under better circumstances but that's a long story. About 6 months ago I discovered a lump in my right breast in my aureola area. I wasn't concerned because I could move it & feel the edges. It appears to be growing from my nipple to below my aureola, it is hard & you can see the lump pushing out from my breast.

Around April the mammogram office started calling me trying to get me in for a annual mammogram. I finally scheduled that on May 23 just so they would stop calling. They conducted a diagnostic mammogram and ultrasound the same day because I have the lump in my breast. I was told by the us tech that it definitely wasn't a cyst and that I should have came in a lot sooner to have the lump checked out. They wanted a ultrasound guided needle biopsy and schedule it for May 29. That morning they called me to cancel the appt saying that after reviewing my mammogram and ultrasound I wouldn't be able to get the needle biopsy because the mass was too close to the surface of my skin and that I needed the lump removed and biopsied instead. They said they tried to get me in with the surgeon that day but he was booked and I had an appt instead the next day, May 30. I was irritated. & when I got home I logged into my patient portal to view the reports & was unimpressed.

I arrived at my appt with the surgeon and he was saying I needed the biopsy. He was extremely rude and wouldn't answer any of my questions during the appt. He is a general surgeon assigned on rotation with others to the Breast Health Clinic. I was trying to find out why they thought it was a bi-rad 4 and told him I could freely move it and have a very long history of lumps in my breast that are nothing to be concerned about. No answers, he would just repeat that the entire team decided I had a "highly suspicious" mass and they all "highly recommended" biopsy. and that bi-rad 4 was "very serious". HE told me the reason I couldn't get the needle biopsy was because "everyone is scared of implants". I have under the muscle saline implants & have had them since 2005. I don't want to have to go through an unnecessary surgery every time I have a lump in my breast and especially when I am getting ready to go on a two week vacation in July. He is also refusing to do any other incision other than an areola incision because of my implants and I had that incision for my 2010 biopsy and suffered nerve damage to my nipple as a result. He didn't even know that was a possible risk with that incision location. So needless to say I'm not looking forward to all of this, especially since it's probably for nothing.

Under pressure I caved and allowed them to schedule me for surgery on June 14th to remove the mass. Unfortunately, that's also my husband's birthday Yeah, this just keeps getting better. Below is what my mammogram and us report say. It looks like to me that a mammogram is still of no use to me because it didn't pick up the obvious lump and I don't see anything too concerning in the vague us report. Of note, this is all occurring at a military hospital. So... is this anything to be concerned about and considering my history what can I do in the future to prevent unnecessary surgeries? I have very little breast tissue and my implants have compacted it so any removals are going to leave some amount of disfigurement. I now have flat area on my left breast from the 2010 removal & that one was deeper in my tissue.

Compared with prior mammographic examination from 26 March 2010

Findings: Diffuse amount of bilateral essentially symmetric heterogenously dense fibroglandular tissue is present without suspicious dominant masses or suspicious cluster of microclassifications. Intact bilateral breast implants.

Sonographic and Doppler evaluation at patient designated location of palpable abnormality in the right breast along the 5:30 axis approximately 1 to 2 cm from the nipple demonstrates a 1.5 x 0.9 cm mass in the superficial soft tissues. There is apparent increased vascular flow.

Impression: Suspicious abnormality

Bi-rads 4: Suspicious abnormality. Recommend biopsy.