Fibroadenoma is the most common benign breast tumor in younger women, representing nearly half of breast lumps diagnosed below 30 years of age, and frequently causes pain, anxiety, or cosmetic concern leading to medical evaluation [1]. Although traditional open lumpectomy achieves complete removal, it is accompanied by postoperative pain, visible scars and alteration of breast contour, which may create psychological distress, particularly in adolescents and young adults [2]. The need for improved cosmetic outcomes gave rise to minimally invasive alternatives such as vacuum-assisted breast biopsy (VABB), which was originally introduced as a diagnostic method but is now widely used for therapeutic excision of benign breast lesions [3]. VABB allows complete removal of nodules through a 3–5 mm skin incision, using a rotating cutting device with vacuum suction, while preserving normal breast tissue architecture [4]. Several international studies have confirmed that VABB is capable of excising 90–100% of benign breast lesions with minimal complications, faster recovery, and excellent cosmetic satisfaction [5,6]. It is also advantageous in sampling small or deep lesions, in micro calcified BI-RADS IV abnormalities where core biopsy may be technically difficult, and in removing intraductal papilloma’s presenting with nipple discharge [7,8]. Despite substantial evidence from Europe and the United States, Indian experience with VABB remains limited and underreported. This case series therefore documents real-world therapeutic outcomes of VABB in symptomatic and radiologically suspicious benign breast lesions in a tertiary care center.

This case series was conducted in the Department of Radiology, Kiran Medical College, Surat, Gujarat, India. Women presenting with clinically or radiologically detected breast lesions who met the eligibility criteria and provided written informed consent were included. Ethical clearance was obtained from the Institutional Ethics Committee prior to initiation of the study. Study population All female patients with: • palpable breast lumps suggestive of fibroadenoma, • recurrent breast nodules following previous excision, • BI-RADS category III or IV lesions that warranted tissue diagnosis, • nipple discharge suspected to be due to intraductal papilloma, were enrolled prospectively. Patients with known bleeding disorders, anticoagulant use, active infection at the needle entry site, or radiologically suspicious multifocal malignancy were excluded. Case 1 A 50-year-old woman presented with painful bilateral breast masses for 10 years. She previously underwent two open surgeries, resulting in painful scars. Ultrasound-guided VABB was performed on both sides under local anesthesia. The procedure was painless and scarless. Immediate pain relief was achieved with no post-procedure hemorrhage or infection. Histopathology: Inflamed lymph node and fibroadenoma features. Outcome: Complete symptom relief; no recurrence reported Case 2. A 30-year-old female with three FNAC-proven fibroadenomas in the right breast for eight years. All lesions were removed in a single sitting using VABB. The ultrasound findings demonstrate three discrete lesions in the right breast. The first lesion measures 18 × 12 × 7 mm, located at the 2 o’clock position in the inner-upper quadrant. It is situated 11 mm from the nipple and 69 mm away from the skin, indicating that the lesion lies relatively deep within the parenchyma. The second lesion measures 44 × 41 × 18 mm, positioned at 3 o’clock, corresponding to the inner-central quadrant. This lesion is only 2 mm from the nipple and 2 mm from the overlying skin, suggesting a very superficial and retro areolar location, making it easily palpable and potentially more noticeable clinically. The third lesion measures 29 × 24 × 18 mm, located at 8 o’clock in the outer-lower quadrant, 21 mm away from the nipple and 4 mm from the skin, indicating a relatively superficial lesion near the lower lateral breast. Outcome: Rapid recovery, no complications. Case 3 A 19-year-old medical student presented with pain in the left breast. She previously underwent lumpectomy 4 years earlier, leaving a painful scar. New fibroadenomas were detected, increasing in size on 3-month follow-up. The ultrasound report shows multiple small lesions in both breasts, most of them located in the outer quadrants. In the right breast, one lesion in the inner-lower quadrant measures 12 × 10 × 7 mm, and another in the outer-central quadrant measures 14 × 11 × 7 mm. Both are close to the nipple and skin, suggesting superficial, easily accessible benign nodules. In the left breast, a 6 × 3 mm lesion is noted in the outer-upper quadrant, while two lesions measuring 13 × 8 × 6 mm and 12 × 12 × 5 mm lie in the outer-lower quadrant. These lesions also lie close to the nipple and skin. Because the lesions are small, well-defined, and multiple on both sides, the impression favors multiple benign nodules, most likely fibroadenomas. VABB performed: Complete removal of all lesions, avoiding a second surgical scar. Outcome: Pain relief; cosmetically superior result. Case 4 A 49-year-old woman undergoing screening mammography showed developing asymmetry and increased microcalcifications in the right breast (BI-RADS IV-B). The lesion measured 5×3×3 mm at the 10 o’clock position. Due to very small size, core biopsy was difficult; hence VABB was selected. A marker clip was placed post-excision for follow-up. Outcome: Successful lesion removal and histopathological clarification. Case 5 The ultrasound findings show multiple small, well-defined lesions in both breasts, most of which have smooth margins and are located close to the skin and nipple. Their size ranges from very small (3–6 mm) to moderately small (10–14 mm), and they are located in different quadrants on both sides. Because these nodules appear oval, well-circumscribed, and non-aggressive, the overall impression strongly suggests multiple benign breast lesions, most likely fibroadenomas. VABB performed for multiple lumps in the left breast. Histopathology: • Fibroadenoma with stromal hyalinisation • Fibroadenomatoid foci • Adenosis and fibrocystic changes No atypia or malignancy detected. A 60-year-old woman, treated case of carcinoma of the right breast, presented with clear nipple discharge from the left breast. VABB Findings: Intraductal papilloma with focal usual ductal hyperplasia; no in-situ or invasive malignancy. Immunohistochemistry: P63, CK5/6 positive; heterogeneous ER/PR positivity. Outcome: Symptom resolution with minimally invasive approach. Case 7 A 56-year-old woman with bloody nipple discharge. Ultrasound-guided VABB excised a 10×4×2 mm intraductal mass (BI-RADS IV-B). Histopathology: Intraductal papilloma with usual ductal hyperplasia. Outcome: Symptom completely resolved; no complications. Case 8 A 39-year-old woman with a 60×53×34 mm hard mass in the upper outer quadrant of right breast. VABB Histopathology: • Stromal sclerosis • Acute suppurative and chronic inflammation • Non-infectious granulomatous reaction/duct ectasia • No tuberculosis or malignancy.

Nine women, aged between 17 and 60 years, underwent ultrasound-guided VABB under local anesthesia. The spectrum of presentations included multiple fibroadenomas, painful recurrent nodules following previous lumpectomy, BI-RADS IV microcalcifications, intraductal papilloma with nipple discharge, and a granulomatous inflammatory mass mimicking neoplastic pathology. VABB allowed total removal of breast lesions through a single small skin entry without the use of sutures, thus avoiding scarring. Histopathology confirmed fibroadenoma or fibro adenomatoid change in six patients, two cases revealed intraductal papilloma with usual ductal hyperplasia, and one case demonstrated stromal sclerosis with a non-infectious granulomatous response suggestive of duct ectasia. No atypia or malignancy was detected in any specimen, and tissue volume was adequate for definitive diagnosis, consistent with previously published reports showing superior diagnostic yield of VABB compared to standard 14-gauge core needle biopsy [7]. One patient with a 5×3×3 mm BI-RADS IV lesion underwent VABB because the lesion was too small and deep for routine core biopsy; successful complete removal was achieved and a clip marker was placed for future mammographic surveillance, reflecting recognized international clinical practice [8]. Clinical outcomes were consistently favorable. Patients with painful fibroadenomas experienced immediate relief following excision. In young women with prior open lumpectomy scars, VABB prevented further disfiguration and eliminated the need for repetitive surgical incisions. Both patients with intraductal papilloma experienced complete resolution of nipple discharge following removal, supporting previously documented effectiveness of VABB in papilloma management [9]. No patient in the series experienced hemorrhage, hematoma, infection, skin necrosis, or delayed complications during follow-up. These findings mirror large clinical series, such as the Korean experience of 576 cases, where complication rates were below 1% and mostly self-limited [10]. None of the women required hospitalization, and all returned to routine activity shortly after the procedure. Cosmetic satisfaction was uniformly excellent. The therapeutic and psychological advantages of VABB are particularly valuable in young patients for whom breast appearance is an important concern. International studies report high patient acceptance and excellent cosmetic outcomes due to the small incision and preservation of breast shape [5,6]. Our experience echoes these results, especially in adolescents and young adults who presented with anxiety related to lump appearance, pain, or fear of cancer. VABB thus serves not only as a method of tissue diagnosis but also as a definitive therapeutic solution. Its minimally invasive nature, negligible complication profile, and outpatient feasibility position it as a superior alternative to surgical excision for most benign breast lesions. While long-term recurrence data from Indian populations are still evolving, global evidence suggests a low recurrence rate when complete excision is achieved [6]. Overall, this case series demonstrates that VABB is safe, effective and aesthetically advantageous for benign breast lesions including fibroadenomas, papilloma’s, granulomatous inflammatory masses, and small BI-RADS IV lesions. It offers rapid symptomatic relief, high diagnostic accuracy, elimination of surgical scarring, and short recovery time. In modern breast practice, VABB may be preferred over open excision in appropriate patients, particularly young women, patients with multiple nodules, recurrent lesions, or cosmetically sensitive cases. Future larger studies in Indian settings are warranted to evaluate long-term recurrence rates, cost-effectiveness, and patient-reported outcomes.

VABB proved to be a safe, effective, and scar-less option for removing benign breast lesions in this case series. All patients had complete lesion excision with immediate symptom relief and no major complications. Cosmetic outcomes were excellent, especially in young women and those with recurrent or multiple fibroadenomas. These findings support VABB as a reliable minimally invasive alternative to open surgery for selected benign breast lesions.

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