817 Our Experience of Management of Nipple Discharge

Abstract

Abstract Aim Evaluation of nipple discharge is a multidisciplinary practice requiring careful evaluation of the patient, their age and history. This study considers whether smoking is a contributory factor and if microdochectomy or Hadfield's procedure offered any additional benefit. Method A retrospective analysis of all patients undergoing microdochectomy or a Hadfield's procedure for nipple discharge over the last three years (2019–2021) at a DGH breast unit was undertaken. Patient demographics, smoking history, pre-operative imaging, and histopathological findings were accessed from the patient electronic records. Results 38 patients were included in this study, 29 patients undergoing a Hadfield's procedure, and 9 a microdochectomy. 82% of patients were non-smokers (n=31), 8% (n=3) were ex-smokers, 3% (n=1) heavy smokers, and 8% of records were not available. 45% (n=17) presented with bloody discharge. Histologically the main diagnoses were duct ectasia found in 29% (n=11) of patients, papilloma in 47% (n=18), combined duct ectasia and papilloma in 5% (n=2), benign breast changes in 13% (n=5), duct ectasia and squamous metaplasia of lactiferous ducts (SMOLD) in 3% (n=1) and focal apocrine metaplasia in 3% (n=1). In 5% (n = 2) there was a small focus of low-grade DCIS which needed further wide local excision. Conclusion Smoking was not found to be a major contributing factor in the aetiology of nipple discharge. Although less surgically invasive options such as microdochectomy should be considered, the duration and age of a patient should be considered to reduce the small risk of missing non-calcifying DCIS, not visible on preoperative imaging mammogram.