Microdochetomy & Total Duct Excision

MICRODOCHECTOMY & TOTAL DUCT EXCISION

Nipple discharge, even in the absence of clinical or imaging findings, may require surgery to remove the ducts behind the nipple to stop the discharge and to provide tissue to the pathologist to identify the cause of the discharge.

Microdochectomy is a targeted surgical procedure where a single duct behind the nipple is removed. It is usually recommended for discharge from a single duct in the nipple. It is suitable for younger women who wish to preserve the ability to breastfeed after surgery.

Total duct excision is a surgical procedure where all the ducts behind the nipple are removed. It is usually recommended for discharge from multiple ducts in the nipple or persistent discharge after microdochectomy. 

How are microdochectomy and total duct excision performed? 

Microdochectomy and total duct excision are performed under general anaesthesia. A single dose of intravenous antibiotics is given at the start of surgery. 

The incision is placed along the edge of the brown area around your nipple, known as periareolar incision. 

Microdochectomy involves the removal of a single duct. The specific duct responsible for the discharge is identified and isolated with a fine probe. The duct is removed without damaging the remaining ducts.

Total duct excision involves removal of all the major ducts from behind the nipple.

The incision is infiltrated with local anaesthetic and closed with dissolvable sutures and skin glue, and covered with a waterproof dressing. 

The procedure takes around 60 minutes.

What is the expected recovery after microdochectomy and total duct excision?

Hospital Stay. Most people go home on the day of surgery. It is recommended that you be accompanied home by a carer who will stay with you (or very close by) for the first 24 to 48 hours.

Wound Care. Your wound is closed with dissolvable sutures and skin glue and covered with a waterproof dressing. Remove your dressings in 2 weeks - your wounds should be healed by then and you do not need further dressings. You can massage your scar at 3 weeks using a plain moisturiser with firm circular motions for at least 10 minutes twice a day.

Bras. You may feel more comfortable wearing a supportive wire-free bra for the first few days.

Driving. You should not drive for at least 24 hours after general anaesthesia.

Physical Activity. You are encouraged to do as much walking as is comfortable. Avoid lifting (over 5 kg), pushing or pulling for 2 weeks - this includes lifting children and housework such as vacuuming or hanging out the washing. Avoid exercises that create a lot of 'breast bounce' for 2 weeks - such as jogging or cardio sessions. 

What are the risks of microdochectomy and total duct excision?

All surgery has risks despite the highest standard of practice. Some of the possible risks associated with microdochectomy and total duct excision include:

  • Bleeding
  • Infection
  • Unacceptable scarring, including hypertrophic or keloid scars
  • Changes in nipple sensation (temporary or permanent)
  • Loss of nipple skin
  • Breastfeeding is possible after microdochectomy but not after total duct excision
  • Recurrence of symptoms

What is the cost of surgery?

For patients with private health insurance, there is no out of pocket fee for the surgeon (as long as you are covered for item numbers 31553 - microdochectomy or 31556 - total duct excision). There may be additional costs related to anaesthetist’s fee, hospital excess and pathology services. 

For patients without private health insurance, please contact us for a quote. 


Dr Mary Ling performs breast surgery at Gosford Private Hospital and Brisbane Waters Private Hospital on the Central Coast. Dr Ling welcomes patients from Newcastle, Lake Macquarie, the Hunter Region and Northern NSW. 

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