Whether breast 4a requires surgery or conservative treatment is related to the type of pathology, the specifics of the condition, and the progression of the disease, and it is impossible to generalize. It is recommended that further examination be performed to clarify the specific type of pathology before choosing the appropriate treatment. A breast nodule of 4a indicates an increased risk of malignancy and the possibility of cancer in the pathologic type, probably between 3% and 10%. If they are non-malignant and not particularly serious, they do not require surgical treatment and regular review is sufficient; they can also be surgically removed when they are large and compress the surrounding milk ducts and glands. If the nodule is malignant, surgical excision is required. Whether breast 4a is recommended to be operated or conservative should be analyzed on a case-by-case basis. Further puncture biopsy is recommended to clarify the nature of the pathology, which will help in the subsequent treatment and avoid the possibility of malignant changes.