Microdochectomy

Microdochectomy is the surgical removal (excision) of a lactiferous duct. A mere incision of a mammary duct (without excision) is called microdochotomy.[1]

Microdochectomy
Specialtysurgical oncology

Indication

Microdochectomy is a standard treatment of in case there is nipple discharge which stems from a single duct.[2] 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.[3]

Duct excision may also be indicated for the treatment of recurrent breast abscess and mastitis;[4] in this case however the total removal of all ducts from behind the nipple has been recommended to avoid further recurrence.[5]

Galactography may be used to investigate the condition of the mammary duct system before the intervention.[6] Pre-operatively, also breast ultrasound and mammogram are performed to rule out other abnormalities of the breast.[6]

If the condition involves only a single duct, then microdochectomy may be indicated, in particular in women wishing to preserve the ability to breastfeed;[7] 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.[2]

Procedure

A radial cut or preferably[7] 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.[6]

The excision can be directed by ductoscopy.[5]

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.[8] Furthermore, infection or hematoma may occur, and there may be a poor cosmetic result.[9]

References
  1. "Microdochotomy". Systematized Nomenclature of Medicine - Clinical Terms. Retrieved 4 November 2014.
  2. Nigel Rawlinson; Derek Alderson (29 September 2010). Surgery: Diagnosis and Management. John Wiley & Sons. p. 219. ISBN 978-1-4443-9122-0.
  3. Makita, Masujiro; Akiyama, Futoshi; Gomi, Naoya; Iwase, Takuji (2014). "Mammary ductoscopy and watchful follow-up substitute microdochectomy in patients with bloody nipple discharge". Breast Cancer. 23 (2): 242–251. doi:10.1007/s12282-014-0561-z. ISSN 1340-6868. PMID 25150843. S2CID 36404518.
  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 (review). 31 (6): 1683–99. doi:10.1148/rg.316115521. PMID 21997989., p. 1694
  5. 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. Brendon J Coventry (17 January 2014). Breast, Endocrine and Surgical Oncology. Springer Science & Business Media. p. 23. ISBN 978-1-4471-5421-1.
  7. J Michael Dixon (22 June 2013). Breast Surgery: Companion to Specialist Surgical Practice. Elsevier Health Sciences. p. 275. ISBN 978-0-7020-4967-5.
  8. Christopher Chan; Christopher L. H. Chan; Alister J. Hart (2001). Viva Practice for Intercollegiate MRCS. PasTest Ltd. p. 108. ISBN 978-1-904627-19-7.
  9. William E. G. Thomas; Norbert Senninger (1 February 2008). Short Stay Surgery. Springer Science & Business Media. p. 136. ISBN 978-3-540-69028-3.
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