Central duct excision
{{Infobox medical intervention
| name = Central duct excision
| synonym =major duct excision or Hadfield's procedure
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Central duct excision is the surgical removal (excision) of all lactiferous duct under the nipple. The excision of a single duct is called microdochectomy, a mere incision of a mammary duct (without excision) is microdochotomy.{{cite web|url=http://bioportal.bioontology.org/ontologies/SNOMEDCT?p=classes&conceptid=172109000|title=Microdochotomy|publisher=Systematized Nomenclature of Medicine - Clinical Terms|accessdate=4 November 2014}}
Indication
Central duct excision is a standard treatment of in case there is nipple discharge which stems from multiple ducts or cannot be traced back to a single duct.{{cite book|author1=Nigel Rawlinson|author2=Derek Alderson|title=Surgery: Diagnosis and Management|url=https://books.google.com/books?id=fxbDsuew0IkC&pg=PA219|date=29 September 2010|publisher=John Wiley & Sons|isbn=978-1-4443-9122-0|pages=219}} It is also indicated if there is bloody nipple discharge in patients beyond childbearing age.{{cite book|author1=R. E. Mansel|author2=David J. T. Webster|author3=Helen Sweetland|title=Hughes, Mansel & Webster's Benign Disorders and Diseases of the Breast|url=https://books.google.com/books?id=HtP4hydafmsC&pg=PA312|year=2009|publisher=Elsevier Health Sciences|isbn=978-0-7020-2774-1|pages=312}}
Duct excision may be indicated for the treatment of recurrent breast abscess and mastitis,{{cite journal |vauthors=Trop I, Dugas A, David J, El Khoury M, Boileau JF, Larouche N, Lalonde L |title=Breast abscesses: evidence-based algorithms for diagnosis, management, and follow-up |journal=Radiographics |volume=31 |issue=6 |pages=1683–99 |date=October 2011 |pmid=21997989 |doi=10.1148/rg.316115521 |type=review}}, p. 1694 and the total removal of all ducts from behind the nipple has been recommended to avoid further recurrence.{{cite book|author=J Michael Dixon|title=Breast Surgery: Companion to Specialist Surgical Practice|url=https://books.google.com/books?id=_luP4nceyDkC&pg=PA275|date=22 June 2013|publisher=Elsevier Health Sciences|isbn=978-0-7020-4967-5|pages=276}} In particular if the patient wishes to preserve breastfeeding ability,{{cite book|author=J Michael Dixon|title=Breast Surgery: Companion to Specialist Surgical Practice|url=https://books.google.com/books?id=_luP4nceyDkC&pg=PA274|date=22 June 2013|publisher=Elsevier Health Sciences|isbn=978-0-7020-4967-5|pages=274}} the condition of the mammary duct system is investigated by means of galactography (ductography) or ductoscopy in order to determine whether the excision of a single duct (microdochectomy) would be sufficient.{{cite book|author=Brendon J Coventry|title=Breast, Endocrine and Surgical Oncology|url=https://books.google.com/books?id=kN29BAAAQBAJ&pg=PA23|date=17 January 2014|publisher=Springer Science & Business Media|isbn=978-1-4471-5421-1|pages=23}}
Pre-operatively, also breast ultrasound and mammogram are performed to rule out other abnormalities of the breast.
Procedure
A circumareolar cut (following the circular line of the areola) is made, the ducts are divided from the underside of the nipple, and the surrounding breast tissue is removed to a depth of 2–3 cm behind the nipple-areola complex.{{cite book|author1=William E. G. Thomas|author2=Norbert Senninger|title=Short Stay Surgery|url=https://books.google.com/books?id=98ayAtsiasMC&pg=PA138|date=1 February 2008|publisher=Springer Science & Business Media|isbn=978-3-540-69028-3|pages=138}}
Complications
Possible complications of the procedure include nipple tip necrosis, in which case further surgery may become necessary to recreate the nipple.{{cite book|author=Brendon J Coventry|title=Breast, Endocrine and Surgical Oncology|url=https://books.google.com/books?id=kN29BAAAQBAJ&pg=PA23|date=17 January 2014|publisher=Springer Science & Business Media|isbn=978-1-4471-5421-1|pages=24}} A further complication is altered sensation, shape, size and color of the nipple, including nipple inversion. Furthermore, infection or hematoma may occur. These risks are higher than they are for the microdochectomy procedure.
After all or most ducts are excised, breastfeeding is no longer possible.{{cn|date=January 2022}}