Malignant phyllodes tumors (MPT) have always been a great deal of controversy among fibroepithelial tumors of the breast. Genetics, histopathology, and tumor behavior on the cellular scale shape their extent of aggressiveness. Diagnosis is based on radiological and pathological findings. Cure is surgical excision. This article reveals the most common clinical indices, which should raise the surgeon's concerns on a benign‐looking tumor to further investigate its nature, and the importance of an adequate surgical intervention, preferably done by an oncoplastic breast surgeon, in order to accomplish the ideal outcome for the patient.

Key Clinical MessageThe approach to toothpick ingestion and its complications should not be underestimated. The surgeon should be prepared for life‐threatening situations such as major vascular involvement, as well as highly specialized and technically challenging procedures, when the hepatic hilum is involved for instance. Referral to tertiary centers is sometimes mandatory.

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