Central duct excision

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Central duct excision
Other namesmajor duct excision or Hadfield's procedure

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. [1]

Contents

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.[ citation needed ]

Related Research Articles

Breast Region of the torso of a primate containing the mammary gland

The breast is one of two prominences located on the upper ventral region of a primate's torso. In females, it serves as the mammary gland, which produces and secretes milk to feed infants. Both females and males develop breasts from the same embryological tissues. At puberty, estrogens, in conjunction with growth hormone, cause breast development in female humans and to a much lesser extent in other primates. Breast development in other primate females generally only occurs with pregnancy.

Nipple Part of the breast

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 muscle contractions that occur along with the ductal system. The nipple is surrounded by the areola, which is often a darker colour than the surrounding skin. A nipple is often called a teat when referring to non-humans. Nipple or teat can also be used to describe the flexible mouthpiece of a baby bottle. In humans, the nipples of both males and females can be stimulated as part of sexual arousal. In many cultures, human female nipples are sexualized, or "regarded as sex objects and evaluated in terms of their physical characteristics and sexiness."

Areola

The human areola 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 areas such as an inflamed region of skin.

Mastitis Medical condition

Mastitis is inflammation of the breast or udder, usually associated with breastfeeding. Symptoms typically include local pain and redness. There is often an associated fever and general soreness. Onset is typically fairly rapid and usually occurs within the first few months of delivery. Complications can include abscess formation.

Pagets disease of the breast Medical condition

Paget's disease of the breast is a type of cancer that outwardly may have the appearance of eczema, with skin changes involving the nipple of the breast. The condition is an uncommon disease accounting for 1 to 4.3% of all breast cancers and was first described by Sir James Paget in 1874.

Nipple discharge Medical condition

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.

Inverted nipple Medical condition

An inverted nipple is a condition where the nipple, instead of pointing outward, is retracted into the breast. In some cases, the nipple will be temporarily protruded if stimulated. Both women and men can have inverted nipples.

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 muscle contractions along the ductal system to the tip of the nipple. They are also referred to as galactophores, galactophorous ducts, mammary ducts, mamillary ducts or milk ducts.

Amastia refers to a rare clinical anomaly in which both internal breast tissue and the visible nipple are absent on one or both sides. It affects both men and women. Amastia can be either isolated or comorbid with other syndromes, such as ectodermal dysplasia, syndactaly and lipoatrophic diabetes. This abnormality can be classified into various types, and each could result from different pathologies. Amastia differs from amazia and athelia. Amazia is the absence of one or both mammary glands but the nipples remain present, and athelia is the absence of one or both nipples, but the mammary gland remains.

Ptosis (breasts) Medical condition

Ptosis or sagging of the female breast is a natural consequence of aging. The rate at which a woman's breasts drop and the degree of ptosis depends on many factors. The key factors influencing breast ptosis over a woman's lifetime are cigarette smoking, her number of pregnancies, higher body mass index, larger bra cup size, and significant weight change. Post-menopausal women or people with collagen deficiencies may experience increased ptosis due to a loss of skin elasticity. Many women and medical professionals mistakenly believe that breastfeeding increases sagging. It is also commonly believed that the breast itself offers insufficient support and that wearing a bra prevents sagging, which has not been found to be true.

Ductal carcinoma in situ Medical condition

Ductal carcinoma in situ (DCIS), also known as intraductal carcinoma, is a pre-cancerous or non-invasive cancerous lesion of the breast. DCIS is classified as Stage 0. It rarely produces symptoms or a breast lump one can feel, typically being detected through screening mammography.

Breast surgery is a form of surgery performed on the breast.

Lactation Regulated release of milk from the mammary glands and the period of time that a mother lactates to feed her young

Lactation describes the secretion of milk from the mammary glands and the period of time that a mother lactates to feed her young. The process naturally occurs with all post-pregnancy female mammals, although it may predate mammals. The process of feeding milk in all animals is called nursing, and in humans it is also called breastfeeding. Newborn infants often produce some milk from their own breast tissue, known colloquially as witch's milk.

The term nonpuerperal mastitis describes inflammatory lesions of the breast (mastitis) that occur unrelated to pregnancy and breastfeeding.

Also called Zuska's disease, subareolar abscess is a subcutaneous abscess of the breast tissue beneath the areola of the nipple. It is a frequently aseptic inflammation and has been associated with squamous metaplasia of lactiferous ducts.

Nipple adenoma Medical condition

A nipple adenoma is a rare benign tumour of the breast.

Galactography or ductography 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. The procedure is used for investigating the pathology of nipple discharge.

Microdochectomy is the surgical removal (excision) of a lactiferous duct. A mere incision of a mammary duct is called microdochotomy.

Mammary alveolus Small cavity or sac found in the mammary gland

A mammary alveolus is a small cavity or sac found in the mammary gland. Mammary alveoli are the site of milk production and storage in the mammary gland. Mammary alveoli cluster into groups called mammary lobules, and each breast may contain 15 to 20 of these lobules. The lobules drain milk through the lactiferous ducts out of the nipples.

Nipple stimulation Human sexual practice

Nipple stimulation or breast stimulation is stimulation of the breast. Stimulation may be by breastfeeding, sexual activity, or an indirect non-sexual response. As part of sexual activity, the practice may be performed upon, or by, people of any gender or sexual orientation. It may occur with the use of fingers, orally, such as by sucking or licking, as well as by use of an object.

References

  1. "Microdochotomy". Systematized Nomenclature of Medicine - Clinical Terms. Retrieved 4 November 2014.
  2. 1 2 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   978-0-7020-2774-1.
  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. 1 2 3 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. 1 2 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. 1 2 Brendon J Coventry (17 January 2014). Breast, Endocrine and Surgical Oncology. Springer Science & Business Media. p. 23. ISBN   978-1-4471-5421-1.
  8. 1 2 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.