Microdochectomy is the surgical removal (excision) of a

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 ...

. 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 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 a single duct. There are preliminary indications that if

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 ...

and close follow-up are performed, in some cases microdochectomy may not be necessary despite bloody nipple discharge. Duct excision may also be indicated for the treatment of recurrent breast abscess and mastitis;, p. 1694 in this case however the total removal of all ducts from behind the nipple has been recommended to avoid further recurrence.

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 ...

may be used to investigate the condition of the mammary duct system before the intervention. 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, w ...

and

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

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 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 brea ...

; 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 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''. Indication Ce ...

, also called ''Hadfield's procedure'') may be indicated instead.

Procedure

A radial cut or preferably 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 Human body, body with a different histology from the surrounding Tissue (biology), tissu ...

) is made and a milk duct is removed. The removed duct is normally sent for

histologic Histology, also known as microscopic anatomy or microanatomy, is the branch of biology which studies the microscopic anatomy of biological tissues. Histology is the microscopic counterpart to gross anatomy, which looks at larger structures vis ...

examination. The excision can be directed by

Complications

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. Furthermore, infection or hematoma may occur, and there may be a poor cosmetic result.

References

External links

Microdochectomy
Systematized Nomenclature of Medicine - Clinical Terms
Breast Microdochotomy/Microdochectomy (patient consent form)
Queensland government {{Breast procedures Breast surgery Surgical removal procedures