microdochectomy

Microdochectomy is a standard treatment of in case there is nipple discharge which stems from 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}} 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.{{cite journal|last1=Makita|first1=Masujiro|last2=Akiyama|first2=Futoshi|last3=Gomi|first3=Naoya|last4=Iwase|first4=Takuji|title=Mammary ductoscopy and watchful follow-up substitute microdochectomy in patients with bloody nipple discharge|journal=Breast Cancer|volume=23|issue=2|pages=242–251|year=2014|issn=1340-6868|doi=10.1007/s12282-014-0561-z|pmid=25150843|s2cid=36404518}}

Duct excision may also 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 in this case however 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}}

Galactography may be used to investigate the condition of the mammary duct system before the intervention.{{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.

If the condition involves only a single duct, then microdochectomy may be indicated, in particular in women wishing to preserve the ability to breastfeed;{{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=275}} 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.

A radial cut or preferably 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.

The excision can be directed by ductoscopy.

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.{{cite book|author1=Christopher Chan|author2=Christopher L. H. Chan|author3=Alister J. Hart|title=Viva Practice for Intercollegiate MRCS|url=https://books.google.com/books?id=6bQ-Dtj4bCgC&pg=PA108|year=2001|publisher=PasTest Ltd|isbn=978-1-904627-19-7|pages=108}} Furthermore, infection or hematoma may occur, and there may be a poor cosmetic result.{{cite book|author1=William E. G. Thomas|author2=Norbert Senninger|title=Short Stay Surgery|url=https://books.google.com/books?id=98ayAtsiasMC&pg=PA136|date=1 February 2008|publisher=Springer Science & Business Media|isbn=978-3-540-69028-3|pages=136}}

{{reflist}}

• [http://bioportal.bioontology.org/ontologies/SNOMEDCT/?p=classes&conceptid=http://purl.bioontology.org/ontology/SNOMEDCT/237400005&jump_to_nav=true Microdochectomy], Systematized Nomenclature of Medicine - Clinical Terms
• [http://www.health.qld.gov.au/consent/documents/breast_02.pdf Breast Microdochotomy/Microdochectomy (patient consent form)], Queensland government

{{Breast procedures}}

Category:Breast surgery

Category:Surgical removal procedures