What are Montgomery tubercles and how are they treated?

Montgomery Tubercles: Definition and Management

Montgomery tubercles are normal sebaceous glands located on the areola of the breast that may become enlarged or prominent, and typically require no treatment unless they become symptomatic or cause psychological distress.

Definition and Anatomy

• Montgomery tubercles are sebaceous glands (also called Montgomery's glands or areolar glands) that appear as small bumps or elevations on the areola surrounding the nipple 1
• They are normal anatomical structures that can become more prominent during pregnancy, lactation, or puberty 2
• These tubercles are connected to lactiferous ducts and can produce secretions that help lubricate and protect the nipple-areolar complex 3

Clinical Presentation

• Montgomery tubercles typically appear as yellowish-pink papules on the areola 1
• They may become enlarged and form what is known as areolar sebaceous hyperplasia (ASH) 4
• In rare cases, they can become obstructed, leading to retroareolar cysts, particularly in pubertal girls 2
• Occasionally, they may produce discharge, which is usually normal but rarely can be bloody 3

Diagnosis

• Diagnosis is typically made through clinical examination 1
• Yellowish-pink papules coalescing into plaques on the areola are characteristic of Montgomery tubercle hyperplasia 1
• In cases of bloody discharge or other concerning symptoms, further investigation may be warranted, including:
  • Mammary ductoscopy to examine the internal duct structure 3
  • Lavage cytology to rule out malignancy 3
  • Biopsy in cases where malignancy cannot be excluded 1

Management

• Most Montgomery tubercles require no treatment as they are normal anatomical structures 1, 4
• Treatment is generally only considered when:
  • They become symptomatic (painful, infected, or produce abnormal discharge) 4, 3
  • They cause significant psychological distress to the patient 4
  • There is a need to rule out malignancy in cases of bloody discharge 3

Treatment Options

• For symptomatic or cosmetically concerning Montgomery tubercles:
  • CO2 laser treatment has shown good response for prominent Montgomery tubercles 4
  • Surgical techniques for reconstruction may be considered in cases where tubercles are absent or damaged and reconstruction is desired 5
  • Microdochectomy may be necessary in cases of persistent bloody discharge to rule out malignancy 3

Special Considerations

• During pregnancy and lactation:
  • Montgomery tubercles often become more prominent as a normal physiological response 1
  • They serve a protective function by secreting substances that lubricate and protect the nipple-areolar complex 3
  • No treatment is typically necessary during these periods unless complications arise 1, 4

Complications and When to Seek Medical Attention

• Medical evaluation should be sought if:
  • There is bloody discharge from a Montgomery tubercle 3
  • There is persistent pain, inflammation, or signs of infection 4
  • Rapid growth or changes in appearance occur that might suggest malignancy 3

Prognosis

• The prognosis for Montgomery tubercles is excellent as they are normal anatomical structures 1
• Even when enlarged or symptomatic, treatment outcomes are generally good with appropriate interventions 4
• Cosmetic results after treatment with CO2 laser or surgical techniques are typically satisfactory 5, 4