| Central duct excision | |
| Synonym: | major 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]
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]
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]
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.