A Microdochectomy is a surgical procedure in which a single duct is removed from the nipple areolar complex. It is usually undertaken when a patient has nipple discharge from a single duct. The patient will be asked not squeeze the nipple before attending the operating theatre.
After informed consent the patient will be placed under a general anaesthetic and a small probe/ wire will be passed into the discharging duct. An incision will be made around the areola and the single offending duct will be excised. The wound will be closed with absorbable sutures and a small waterproof dressing will be placed over the incision.
Possible complications can include wound infection requiring antibiotics.
Bleeding is uncommon, however bruising can occur. There maybe a reduction in nipple sensation and a change to the contour of the nipple and areolar complex. Rarely there can be loss of skin over the nipple.
The aim is to remove a single duct only. The duct that is excised will be sent to a specialist breast pathologist to determine if there is any cause ( eg- papilloma – a small growth, inside the duct) for the nipple discharge.
Total Duct Excision
Indications
Patients who have discharge from multiple ducts
Inverted nipples
Chronic infection beneath the nipples affecting the ducts
Patients that have ongoing persisting nipple discharge post microdochectomy.
This procedure is usually performed as a day case and involves removing all of the ducts which open on to the surface of the nipple. There are approximately 12-15 ducts opening onto the surface of the nipple and some diseases will affect all of the breast ducts.
The operation is performed under a general anaesthetic. A small incision around the areola (the line between the brown area of the nipple and the remaining skin of the breast) is made and all of the ducts are removed and sent for pathological assessment. The wound is closed with absorbable sutures and a waterproof dressing is applied.
Approximately 1 in 3 patients after removal of the ducts from the nipple will have lost sensation to the nipple (numbness). This is more common in women who have had the procedure performed for infection. The symptom of nipple discharge will rarely recur. However, if the operation is performed for eversion (perhaps to correct an inverted nipple) about 10% of these patients will have recurrence of the inversion. Infection of the duct is common in smokers and continuation of smoking can contribute to recurrence of the problem.
Breastfeeding is not possible after total duct excision. There are no concerns if a patient becomes pregnant post operatively. The breasts may feel slightly engorged but they will settle after delivery of the baby.
Complications
Bleeding and bruising can occur post operatively. However, it is uncommon for patients to be returned to the operating theatre to drain a haematoma. Antibiotics will be given during the procedure and postoperatively to reduce the risk of infection. However, despite this a small number of women will get an infection postoperatively. The probability of this occurring is more common if the procedure is being performed for chronic nipple infection.
Occasionally, patients can develop a seroma after the surgery. This is natural fluid secreted by the breast tissue in the cavity where the surgery has been performed and occasionally a needle and syringe will be required to aspirate the fluid postoperatively.
There is always a probability of loss of skin over the nipple with nipple surgery as the blood supply to the nipple can be damaged at the time of surgery which can lead to loss of the nipple. A small scab will occasionally develop over the surface of the nipple and once it separates off the skin, new skin will grow under this
