| Microdochectomy | |
| Specialty: | surgical oncology |
Microdochectomy is the surgical removal (excision) of a lactiferous duct. A mere incision of a mammary duct (without excision) is called microdochotomy.[1]
Microdochectomy is a standard treatment of in case there is nipple discharge which stems from a single duct.[2] There are preliminary indications that if ductoscopy and close follow-up are performed, in some cases microdochectomy may not be necessary despite bloody nipple discharge.[3]
Duct excision may also be indicated for the treatment of recurrent breast abscess and mastitis;[4] in this case however the total removal of all ducts from behind the nipple has been recommended to avoid further recurrence.[5]
Galactography may be used to investigate the condition of the mammary duct system before the intervention.[6] Pre-operatively, also breast ultrasound and mammogram are performed to rule out other abnormalities of the breast.[6]
If the condition involves only a single duct, then microdochectomy may be indicated, in particular in women wishing to preserve the ability to breastfeed;[7] if the condition involves from several ducts or if no specific duct could be determined, then a subareolar resection of the ducts (central duct excision, also called Hadfield's procedure) may be indicated instead.[2]
A radial cut or preferably[7] a circumareolar cut (following the circular line of the areola) is made and a milk duct is removed. The removed duct is normally sent for histologic examination.[6]
The excision can be directed by ductoscopy.[5]
Possible complications of the procedure include temporary or permanent alteration to the shape, sensation or pigmentation of the nipple, such as a minor change to the contour of the nipple-areola region. Although microdochectomy usually preserves the ability to breastfeed, nonetheless the loss of breastfeeding ability is a known complication.[8] Furthermore, infection or hematoma may occur, and there may be a poor cosmetic result.[9]