# Central duct excision

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Medical intervention

Central duct excision Other names major duct excision or Hadfield's procedure [edit on Wikidata]

**Central duct excision** is the surgical removal (excision) of all [lactiferous duct](/source/Lactiferous_duct) under the [nipple](/source/Nipple). The excision of a single duct is called [microdochectomy](/source/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](/source/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](/source/Mastitis#Treatment_of_breast_abscess),[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](/source/Breastfeeding) ability,[6] the condition of the mammary duct system is investigated by means of [galactography](/source/Galactography) (ductography) or [ductoscopy](/source/Ductoscopy) in order to determine whether the excision of a single duct ([microdochectomy](/source/Microdochectomy)) would be sufficient.[2][7]

Pre-operatively, also [breast ultrasound](/source/Breast_ultrasound) and [mammogram](/source/Mammogram) are performed to rule out other abnormalities of the breast.[7]

## Procedure

A circumareolar cut (following the circular line of the [areola](/source/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](/source/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](/source/Inverted_nipple).[5] Furthermore, infection or [hematoma](/source/Breast_hematoma) may occur. These risks are higher than they are for the [microdochectomy](/source/Microdochectomy) procedure.[8]

After all or most ducts are excised, breastfeeding is no longer possible.[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed)*]

## References

1. **[^](#cite_ref-1)** ["Microdochotomy"](http://bioportal.bioontology.org/ontologies/SNOMEDCT?p=classes&conceptid=172109000). Systematized Nomenclature of Medicine - Clinical Terms. Retrieved 4 November 2014.

1. ^ [***a***](#cite_ref-RawlinsonAlderson2010-p219_2-0) [***b***](#cite_ref-RawlinsonAlderson2010-p219_2-1) Nigel Rawlinson; Derek Alderson (29 September 2010). [*Surgery: Diagnosis and Management*](https://books.google.com/books?id=fxbDsuew0IkC&pg=PA219). John Wiley & Sons. p. 219. [ISBN](/source/ISBN_(identifier)) [978-1-4443-9122-0](https://en.wikipedia.org/wiki/Special:BookSources/978-1-4443-9122-0).

1. **[^](#cite_ref-ManselWebster2009-p312_3-0)** R. E. Mansel; David J. T. Webster; Helen Sweetland (2009). [*Hughes, Mansel & Webster's Benign Disorders and Diseases of the Breast*](https://books.google.com/books?id=HtP4hydafmsC&pg=PA312). Elsevier Health Sciences. p. 312. [ISBN](/source/ISBN_(identifier)) [978-0-7020-2774-1](https://en.wikipedia.org/wiki/Special:BookSources/978-0-7020-2774-1).

1. **[^](#cite_ref-trop-etal-2011-p1694_4-0)** Trop I, Dugas A, David J, El Khoury M, Boileau JF, Larouche N, Lalonde L (October 2011). "Breast abscesses: evidence-based algorithms for diagnosis, management, and follow-up". *Radiographics* (review). **31** (6): 1683–99. [doi](/source/Doi_(identifier)):[10.1148/rg.316115521](https://doi.org/10.1148%2Frg.316115521). [PMID](/source/PMID_(identifier)) [21997989](https://pubmed.ncbi.nlm.nih.gov/21997989)., p. 1694

1. ^ [***a***](#cite_ref-Dixon2013-p276_5-0) [***b***](#cite_ref-Dixon2013-p276_5-1) [***c***](#cite_ref-Dixon2013-p276_5-2) J Michael Dixon (22 June 2013). [*Breast Surgery: Companion to Specialist Surgical Practice*](https://books.google.com/books?id=_luP4nceyDkC&pg=PA275). Elsevier Health Sciences. p. 276. [ISBN](/source/ISBN_(identifier)) [978-0-7020-4967-5](https://en.wikipedia.org/wiki/Special:BookSources/978-0-7020-4967-5).

1. ^ [***a***](#cite_ref-Dixon2013-p274_6-0) [***b***](#cite_ref-Dixon2013-p274_6-1) J Michael Dixon (22 June 2013). [*Breast Surgery: Companion to Specialist Surgical Practice*](https://books.google.com/books?id=_luP4nceyDkC&pg=PA274). Elsevier Health Sciences. p. 274. [ISBN](/source/ISBN_(identifier)) [978-0-7020-4967-5](https://en.wikipedia.org/wiki/Special:BookSources/978-0-7020-4967-5).

1. ^ [***a***](#cite_ref-Coventry2014-p23_7-0) [***b***](#cite_ref-Coventry2014-p23_7-1) Brendon J Coventry (17 January 2014). [*Breast, Endocrine and Surgical Oncology*](https://books.google.com/books?id=kN29BAAAQBAJ&pg=PA23). Springer Science & Business Media. p. 23. [ISBN](/source/ISBN_(identifier)) [978-1-4471-5421-1](https://en.wikipedia.org/wiki/Special:BookSources/978-1-4471-5421-1).

1. ^ [***a***](#cite_ref-ThomasSenninger2008-p138_8-0) [***b***](#cite_ref-ThomasSenninger2008-p138_8-1) William E. G. Thomas; Norbert Senninger (1 February 2008). [*Short Stay Surgery*](https://books.google.com/books?id=98ayAtsiasMC&pg=PA138). Springer Science & Business Media. p. 138. [ISBN](/source/ISBN_(identifier)) [978-3-540-69028-3](https://en.wikipedia.org/wiki/Special:BookSources/978-3-540-69028-3).

1. **[^](#cite_ref-Coventry2014-p24_9-0)** Brendon J Coventry (17 January 2014). [*Breast, Endocrine and Surgical Oncology*](https://books.google.com/books?id=kN29BAAAQBAJ&pg=PA23). Springer Science & Business Media. p. 24. [ISBN](/source/ISBN_(identifier)) [978-1-4471-5421-1](https://en.wikipedia.org/wiki/Special:BookSources/978-1-4471-5421-1).

v t e Tests and procedures involving the breast Breast surgery Breast-conserving surgery Lumpectomy Segmental resection Wide local excision Quadrantectomy Mastectomy Radical mastectomy Breast augmentation Trans-umbilical breast augmentation Mammaplasty Breast implant Breast reduction SPAIR Mastopexy Breast reconstruction Interventions on the Lactiferous ducts Ductal lavage Ductoscopy Microdochectomy Central duct excision Breast imaging Mammography Positron emission mammography Tomosynthesis Xeromammography Galactography Breast MRI Breast ultrasound Automated whole-breast ultrasound Scintimammography Elastography Other Breast biopsy Fine-needle aspiration Breast cancer screening Breast self-examination Ductal lavage Breast duct endoscopy

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Adapted from the Wikipedia article [Central duct excision](https://en.wikipedia.org/wiki/Central_duct_excision) by Wikipedia contributors ([contributor history](https://en.wikipedia.org/wiki/Central_duct_excision?action=history)). Available under [Creative Commons Attribution-ShareAlike 4.0 International](https://creativecommons.org/licenses/by-sa/4.0/). Changes may have been made.