Medicine:Microdochectomy
| Microdochectomy | |
|---|---|
| Specialty | surgical oncology |
Microdochectomy is the surgical removal (excision) of a lactiferous duct. A mere incision of a mammary duct (without excision) is called microdochotomy.[1]
Indication
Microdochectomy is a standard treatment of in case there is nipple discharge which stems from a single duct.[2] There are preliminary indications that if ductoscopy and close follow-up are performed, in some cases microdochectomy may not be necessary despite bloody nipple discharge.[3]
Duct excision may also be indicated for the treatment of recurrent breast abscess and mastitis;[4] in this case however the total removal of all ducts from behind the nipple has been recommended to avoid further recurrence.[5]
Galactography may be used to investigate the condition of the mammary duct system before the intervention.[6] Pre-operatively, also breast ultrasound and mammogram are performed to rule out other abnormalities of the breast.[6]
If the condition involves only a single duct, then microdochectomy may be indicated, in particular in women wishing to preserve the ability to breastfeed;[7] if the condition involves from several ducts or if no specific duct could be determined, then a subareolar resection of the ducts (central duct excision, also called Hadfield's procedure) may be indicated instead.[2]
Procedure
A radial cut or preferably[7] a circumareolar cut (following the circular line of the areola) is made and a milk duct is removed. The removed duct is normally sent for histologic examination.[6]
The excision can be directed by ductoscopy.[5]
Complications
Possible complications of the procedure include temporary or permanent alteration to the shape, sensation or pigmentation of the nipple, such as a minor change to the contour of the nipple-areola region. Although microdochectomy usually preserves the ability to breastfeed, nonetheless the loss of breastfeeding ability is a known complication.[8] Furthermore, infection or hematoma may occur, and there may be a poor cosmetic result.[9]
References
- ↑ "Microdochotomy". Systematized Nomenclature of Medicine - Clinical Terms. http://bioportal.bioontology.org/ontologies/SNOMEDCT?p=classes&conceptid=172109000. Retrieved 4 November 2014.
- ↑ 2.0 2.1 Nigel Rawlinson; Derek Alderson (29 September 2010). Surgery: Diagnosis and Management. John Wiley & Sons. pp. 219. ISBN 978-1-4443-9122-0. https://books.google.com/books?id=fxbDsuew0IkC&pg=PA219.
- ↑ Makita, Masujiro; Akiyama, Futoshi; Gomi, Naoya; Iwase, Takuji (2014). "Mammary ductoscopy and watchful follow-up substitute microdochectomy in patients with bloody nipple discharge". Breast Cancer 23 (2): 242–251. doi:10.1007/s12282-014-0561-z. ISSN 1340-6868. PMID 25150843.
- ↑ "Breast abscesses: evidence-based algorithms for diagnosis, management, and follow-up". Radiographics 31 (6): 1683–99. October 2011. doi:10.1148/rg.316115521. PMID 21997989., p. 1694
- ↑ 5.0 5.1 J Michael Dixon (22 June 2013). Breast Surgery: Companion to Specialist Surgical Practice. Elsevier Health Sciences. pp. 276. ISBN 978-0-7020-4967-5. https://books.google.com/books?id=_luP4nceyDkC&pg=PA275.
- ↑ 6.0 6.1 6.2 Brendon J Coventry (17 January 2014). Breast, Endocrine and Surgical Oncology. Springer Science & Business Media. pp. 23. ISBN 978-1-4471-5421-1. https://books.google.com/books?id=kN29BAAAQBAJ&pg=PA23.
- ↑ 7.0 7.1 J Michael Dixon (22 June 2013). Breast Surgery: Companion to Specialist Surgical Practice. Elsevier Health Sciences. pp. 275. ISBN 978-0-7020-4967-5. https://books.google.com/books?id=_luP4nceyDkC&pg=PA275.
- ↑ Christopher Chan; Christopher L. H. Chan; Alister J. Hart (2001). Viva Practice for Intercollegiate MRCS. PasTest Ltd. pp. 108. ISBN 978-1-904627-19-7. https://books.google.com/books?id=6bQ-Dtj4bCgC&pg=PA108.
- ↑ William E. G. Thomas; Norbert Senninger (1 February 2008). Short Stay Surgery. Springer Science & Business Media. pp. 136. ISBN 978-3-540-69028-3. https://books.google.com/books?id=98ayAtsiasMC&pg=PA136.
External links
- Microdochectomy, Systematized Nomenclature of Medicine - Clinical Terms
- Breast Microdochotomy/Microdochectomy (patient consent form), Queensland government
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