What are the indications for microdochectomy and 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 indicated 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 indicated for discharge from multiple ducts in the nipple and persistent discharge after microdochectomy.
How are microdochectomy and total duct excision performed?
Both operations are performed under general anaesthesia. An incision is placed along the line between the brown area around your nipple (the areola) and the remaining skin of the breast (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 closed with dissolvable sutures. The procedure takes around 60 minutes.
What are the risks of microdochectomy and total duct excision?
All surgery has risks despite the highest standard of practice. The following possible complications are listed to inform not to alarm. There may be other complications that are not listed.
- Loss of nipple sensation
- Loss of nipple skin
- Breastfeeding is possible after microdochectomy but not after total duct excision
- Recurrence of symptoms
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 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 or crop top 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 activities that create a lot of ‘breast bounce’ for 4 weeks.
Dr Mary Ling performs breast surgery at Gosford Private Hospital, Brisbane Waters Private Hospital and Tuggerah Lakes Private Hospital on the Central Coast. Dr Ling participates in the No Gap scheme if you have private insurance.