Medicine:Central duct excision
| Central duct excision | |
|---|---|
| Other names | 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]
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]
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.
- ↑ R. E. Mansel; David J. T. Webster; Helen Sweetland (2009). Hughes, Mansel & Webster's Benign Disorders and Diseases of the Breast. Elsevier Health Sciences. pp. 312. ISBN 978-0-7020-2774-1. https://books.google.com/books?id=HtP4hydafmsC&pg=PA312.
- ↑ "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 5.2 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 J Michael Dixon (22 June 2013). Breast Surgery: Companion to Specialist Surgical Practice. Elsevier Health Sciences. pp. 274. ISBN 978-0-7020-4967-5. https://books.google.com/books?id=_luP4nceyDkC&pg=PA274.
- ↑ 7.0 7.1 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.
- ↑ 8.0 8.1 William E. G. Thomas; Norbert Senninger (1 February 2008). Short Stay Surgery. Springer Science & Business Media. pp. 138. ISBN 978-3-540-69028-3. https://books.google.com/books?id=98ayAtsiasMC&pg=PA138.
- ↑ Brendon J Coventry (17 January 2014). Breast, Endocrine and Surgical Oncology. Springer Science & Business Media. pp. 24. ISBN 978-1-4471-5421-1. https://books.google.com/books?id=kN29BAAAQBAJ&pg=PA23.
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