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Central duct excision

Central duct excision (also: major duct excision or Hadfield's procedure) 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.[1]

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.[2] It is also indicated if there is bloody nipple discharge in patients beyond childbearing age.[3]

Duct excision may be indicated for the treatment of recurrent breast abscess and mastitis,[4] and the total removal of all ducts from behind the nipple has been recommended to avoid further recurrence.[5] In particular if the patient wishes to preserve breastfeeding ability,[6] 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.[2][7]

Pre-operatively, also breast ultrasound and mammogram are performed to rule out other abnormalities of the breast.[7]

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.[6][8]

Complications

Possible complications of the procedure include nipple tip necrosis,[5] in which case further surgery may become necessary to recreate the nipple.[9] A further complication is altered sensation, shape, size and color of the nipple, including nipple inversion.[5] Furthermore, infection or hematoma may occur. These risks are higher than they are for the microdochectomy procedure.[8]

After all or most ducts are excised, breastfeeding is no longer possible.

References

  1. ^ "Microdochotomy". Systematized Nomenclature of Medicine - Clinical Terms. Retrieved 4 November 2014. 
  2. ^ a b Nigel Rawlinson; Derek Alderson (29 September 2010). Surgery: Diagnosis and Management. John Wiley & Sons. p. 219. ISBN 978-1-4443-9122-0. 
  3. ^ R. E. Mansel; David J. T. Webster; Helen Sweetland (2009). Hughes, Mansel & Webster's Benign Disorders and Diseases of the Breast. Elsevier Health Sciences. p. 312. ISBN 0-7020-2774-X. 
  4. ^ Trop I, Dugas A, David J, El Khoury M, Boileau JF, Larouche N, Lalonde L (October 2011). "Breast abscesses: evidence-based algorithms for diagnosis, management, and follow-up". Radiographics: a Review Publication of the Radiological Society of North America, Inc (review) 31 (6): 1683–99. PMID 21997989. doi:10.1148/rg.316115521. , p. 1694
  5. ^ a b c J Michael Dixon (22 June 2013). Breast Surgery: Companion to Specialist Surgical Practice. Elsevier Health Sciences. p. 276. ISBN 978-0-7020-4967-5. 
  6. ^ a b J Michael Dixon (22 June 2013). Breast Surgery: Companion to Specialist Surgical Practice. Elsevier Health Sciences. p. 274. ISBN 978-0-7020-4967-5. 
  7. ^ a b Brendon J Coventry (17 January 2014). Breast, Endocrine and Surgical Oncology. Springer Science & Business Media. p. 23. ISBN 978-1-4471-5421-1. 
  8. ^ a b William E. G. Thomas; Norbert Senninger (1 February 2008). Short Stay Surgery. Springer Science & Business Media. p. 138. ISBN 978-3-540-69028-3. 
  9. ^ Brendon J Coventry (17 January 2014). Breast, Endocrine and Surgical Oncology. Springer Science & Business Media. p. 24. ISBN 978-1-4471-5421-1.