{{Infobox medical intervention | name = Central duct excision | synonym =''major duct excision'' or ''Hadfield's procedure'' | image = | caption = | alt = | pronounce = | specialty = <!-- from Wikidata, can be overwritten --> | synonyms = | ICD10 = | ICD9 = | ICD9unlinked = | CPT = | MeshID = | LOINC = | other_codes = | MedlinePlus = | eMedicine = }} '''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''.<ref>{{cite web|url=http://bioportal.bioontology.org/ontologies/SNOMEDCT?p=classes&conceptid=172109000|title=Microdochotomy|publisher=Systematized Nomenclature of Medicine - Clinical Terms|accessdate=4 November 2014}}</ref>

== 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.<ref name="RawlinsonAlderson2010-p219">{{cite book|author1=Nigel Rawlinson|author2=Derek Alderson|title=Surgery: Diagnosis and Management|url=https://books.google.com/books?id=fxbDsuew0IkC&pg=PA219|date=29 September 2010|publisher=John Wiley & Sons|isbn=978-1-4443-9122-0|pages=219}}</ref> It is also indicated if there is bloody nipple discharge in patients beyond childbearing age.<ref name="ManselWebster2009-p312">{{cite book|author1=R. E. Mansel|author2=David J. T. Webster|author3=Helen Sweetland|title=Hughes, Mansel & Webster's Benign Disorders and Diseases of the Breast|url=https://books.google.com/books?id=HtP4hydafmsC&pg=PA312|year=2009|publisher=Elsevier Health Sciences|isbn=978-0-7020-2774-1|pages=312}}</ref>

Duct excision may be indicated for the [[Mastitis#Treatment of breast abscess|treatment of recurrent breast abscess and mastitis]],<ref name="trop-etal-2011-p1694">{{cite journal |vauthors=Trop I, Dugas A, David J, El Khoury M, Boileau JF, Larouche N, Lalonde L |title=Breast abscesses: evidence-based algorithms for diagnosis, management, and follow-up |journal=Radiographics |volume=31 |issue=6 |pages=1683–99 |date=October 2011 |pmid=21997989 |doi=10.1148/rg.316115521 |type=review}}, p.&nbsp;1694</ref> and the total removal of all ducts from behind the nipple has been recommended to avoid further recurrence.<ref name="Dixon2013-p276">{{cite book|author=J Michael Dixon|title=Breast Surgery: Companion to Specialist Surgical Practice|url=https://books.google.com/books?id=_luP4nceyDkC&pg=PA275|date=22 June 2013|publisher=Elsevier Health Sciences|isbn=978-0-7020-4967-5|pages=276}}</ref> In particular if the patient wishes to preserve [[breastfeeding]] ability,<ref name="Dixon2013-p274">{{cite book|author=J Michael Dixon|title=Breast Surgery: Companion to Specialist Surgical Practice|url=https://books.google.com/books?id=_luP4nceyDkC&pg=PA274|date=22 June 2013|publisher=Elsevier Health Sciences|isbn=978-0-7020-4967-5|pages=274}}</ref> 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.<ref name="RawlinsonAlderson2010-p219"/><ref name="Coventry2014-p23">{{cite book|author=Brendon J Coventry|title=Breast, Endocrine and Surgical Oncology|url=https://books.google.com/books?id=kN29BAAAQBAJ&pg=PA23|date=17 January 2014|publisher=Springer Science & Business Media|isbn=978-1-4471-5421-1|pages=23}}</ref>

Pre-operatively, also [[breast ultrasound]] and [[mammogram]] are performed to rule out other abnormalities of the breast.<ref name="Coventry2014-p23"/>

== 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&nbsp;cm behind the nipple-areola complex.<ref name="Dixon2013-p274"/><ref name="ThomasSenninger2008-p138">{{cite book|author1=William E. G. Thomas|author2=Norbert Senninger|title=Short Stay Surgery|url=https://books.google.com/books?id=98ayAtsiasMC&pg=PA138|date=1 February 2008|publisher=Springer Science & Business Media|isbn=978-3-540-69028-3|pages=138}}</ref>

== Complications == Possible complications of the procedure include nipple tip [[necrosis]],<ref name="Dixon2013-p276"/> in which case further surgery may become necessary to recreate the nipple.<ref name="Coventry2014-p24">{{cite book|author=Brendon J Coventry|title=Breast, Endocrine and Surgical Oncology|url=https://books.google.com/books?id=kN29BAAAQBAJ&pg=PA23|date=17 January 2014|publisher=Springer Science & Business Media|isbn=978-1-4471-5421-1|pages=24}}</ref> A further complication is altered sensation, shape, size and color of the nipple, including [[Inverted nipple|nipple inversion]].<ref name="Dixon2013-p276"/> Furthermore, infection or [[Breast hematoma|hematoma]] may occur. These risks are higher than they are for the [[microdochectomy]] procedure.<ref name="ThomasSenninger2008-p138"/>

After all or most ducts are excised, breastfeeding is no longer possible.{{cn|date=January 2022}}

==References== {{reflist|2}}

{{Breast procedures}}

[[Category:Breast surgery]] [[Category:Surgical removal procedures]]