Central duct excision is the surgical removal (excision) of all

lactiferous duct Lactiferous ducts are ducts that converge and form a branched system connecting the nipple to the lobules of the mammary gland. When lactogenesis occurs, under the influence of hormones, the milk is moved to the nipple by the action of smooth mus ...

under the

nipple The nipple is a raised region of tissue on the surface of the breast from which, in females, milk leaves the breast through the lactiferous ducts to feed an infant. The milk can flow through the nipple passively or it can be ejected by smooth mu ...

. The excision of a single duct is called

microdochectomy Microdochectomy is the surgical removal (excision) of a lactiferous duct. A mere incision of a mammary duct (without excision) is called ''microdochotomy''. Indication Microdochectomy is a standard treatment of in case there is nipple discharge w ...

, a mere incision of a mammary duct (without excision) is ''microdochotomy''.

Indication

Central duct excision is a standard treatment of in case there is

nipple discharge Nipple discharge is fluid from the nipple, with or without squeezing the breast. The discharge can be milky, clear, green, purulent, bloody, or faintly yellow. The consistency can be thick, thin, sticky, or watery. Nipple discharge may be norma ...

which stems from multiple ducts or cannot be traced back to a single duct. It is also indicated if there is bloody nipple discharge in patients beyond childbearing age. Duct excision may be indicated for the treatment of recurrent breast abscess and mastitis,, p. 1694 and the total removal of all ducts from behind the nipple has been recommended to avoid further recurrence. In particular if the patient wishes to preserve

breastfeeding Breastfeeding, or nursing, is the process by which human breast milk is fed to a child. Breast milk may be from the breast, or may be expressed by hand or pumped and fed to the infant. The World Health Organization (WHO) recommends that br ...

ability, the condition of the mammary duct system is investigated by means of

galactography Galactography or ductography (or ''galactogram'', ''ductogram'') is a medical diagnostic procedure for viewing the milk ducts. The procedure involves the radiography of the ducts after injection of a radiopaque substance into the duct system throug ...

(ductography) or

ductoscopy Ductoscopy or mammary ductoscopy (also: ''breast duct endoscopy'', ''galactoscopy'') is a medical diagnostic procedure for viewing and collecting epithelial cells and other internal features of the milk ducts. It is capable of detecting smaller abn ...

in order to determine whether the excision of a single duct (

) would be sufficient. Pre-operatively, also

breast ultrasound Breast ultrasound is the use of medical ultrasonography to perform imaging of the breast. It can be considered either a diagnostic or a screening procedure. It may be used either with or without a mammogram. It may be useful in younger women, wh ...

and

mammogram Mammography (also called mastography) is the process of using low-energy X-rays (usually around 30 kVp) to examine the human breast for diagnosis and screening. The goal of mammography is the early detection of breast cancer, typically through d ...

are performed to rule out other abnormalities of the breast.

Procedure

A circumareolar cut (following the circular line of the

areola The human areola (''areola mammae'', or ) is the pigmented area on the breast around the nipple. Areola, more generally, is a small circular area on the body with a different histology from the surrounding tissue, or other small circular ar ...

) 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.

Complications

Possible complications of the procedure include nipple tip

necrosis Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. Necrosis is caused by factors external to the cell or tissue, such as infection, or trauma which result in the unregulated dige ...

, in which case further surgery may become necessary to recreate the nipple. A further complication is altered sensation, shape, size and color of the nipple, including nipple inversion. Furthermore, infection or

hematoma A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillary, capillaries. A he ...

may occur. These risks are higher than they are for the

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

References

{{Breast procedures Breast surgery Surgical removal procedures