The role of major duct excision and microdocectomy in the management of nipple discharge: Diagnostic and therapeutic approach

Abstract

Mammary duct ectasia is considered as a benign condition of the mammary gland. Many theories analyses and summarized the disease regarding the pathogenesis. Firstly, the primary pathological process is due to be involutional and atrophy of the ducts. Other cause of dilation of the ducts, leading to the decrease or absent of secretion, inflammation and duct rupture. Secondly, the causative factor is inflammatory process with periductal inflammation followed by obliteration of ducts, sclerosis of duct and surrounding tissue and duct ectasia. Mostly mammary duct ectasia resolves without any treatment. Applying light warm compresses to nipple and wearing a supportive bra, can help to reduce discomfort of the patient. But If there is evidence of an infection, antibiotics will be prescribed without hesitation. It’s completely prohibited to squeeze the area to increase discharge, as there is increase chance to develop inflammation and infection. If symptoms still persisted than surgery may be done to disconnect the ducts and remove the ducts, Known as Hadfield’s operation. Recently sub-areolar major mammary duct excision – Hadfield’s procedure is very popular and has gained widespread acceptance in management of nipple-areola complex problems like suspicious or troublesome discharge, clinical or sono-mammographic central anomalies and chronic sinus-fistula. Here two cases with nipple discharge managed with two very common surgery with microdocectomy and total duct excision held in Z.H Sikder Women’s Medical College Hospital. Patients were very satisfied with the treatment as they got relief of symptoms and most importantly get rid of the fear of carcinoma.