{{short description|Surgical removal of a lactiferous duct}} {{Infobox medical intervention | name = Microdochectomy | synonym = | image = | caption = | alt = | pronounce = | specialty = surgical oncology | synonyms = | ICD10 = | ICD9 = | ICD9unlinked = | CPT = | MeshID = | LOINC = | other_codes = | MedlinePlus = | eMedicine = }} '''Microdochectomy''' is the surgical removal (excision) of a lactiferous duct. A mere incision of a mammary duct (without excision) is called ''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== Microdochectomy is a standard treatment of in case there is nipple discharge which stems from 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> There are preliminary indications that if ductoscopy and close follow-up are performed, in some cases microdochectomy may not be necessary despite bloody nipple discharge.<ref name="MakitaAkiyama2014">{{cite journal|last1=Makita|first1=Masujiro|last2=Akiyama|first2=Futoshi|last3=Gomi|first3=Naoya|last4=Iwase|first4=Takuji|title=Mammary ductoscopy and watchful follow-up substitute microdochectomy in patients with bloody nipple discharge|journal=Breast Cancer|volume=23|issue=2|pages=242–251|year=2014|issn=1340-6868|doi=10.1007/s12282-014-0561-z|pmid=25150843|s2cid=36404518|doi-access=free}}</ref>
Duct excision may also be indicated for the 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. 1694</ref> in this case however 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>
Galactography may be used to investigate the condition of the mammary duct system before the intervention.<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"/>
If the condition involves only a single duct, then microdochectomy may be indicated, in particular in women wishing to preserve the ability to breastfeed;<ref name="Dixon2013-p275">{{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=275}}</ref> if the condition involves from several ducts or if no specific duct could be determined, then a subareolar resection of the ducts (central duct excision, also called ''Hadfield's procedure'') may be indicated instead.<ref name="RawlinsonAlderson2010-p219"/>
==Procedure== A radial cut or preferably<ref name="Dixon2013-p275"/> a circumareolar cut (following the circular line of the areola) is made and a milk duct is removed. The removed duct is normally sent for histologic examination.<ref name="Coventry2014-p23"/>
The excision can be directed by ductoscopy.<ref name="Dixon2013-p276"/>
==Complications== Possible complications of the procedure include temporary or permanent alteration to the shape, sensation or pigmentation of the nipple, such as a minor change to the contour of the nipple-areola region. Although microdochectomy usually preserves the ability to breastfeed, nonetheless the loss of breastfeeding ability is a known complication.<ref>{{cite book|author1=Christopher Chan|author2=Christopher L. H. Chan|author3=Alister J. Hart|title=Viva Practice for Intercollegiate MRCS|url=https://books.google.com/books?id=6bQ-Dtj4bCgC&pg=PA108|year=2001|publisher=PasTest Ltd|isbn=978-1-904627-19-7|pages=108}}</ref> Furthermore, infection or hematoma may occur, and there may be a poor cosmetic result.<ref name="ThomasSenninger2008-p136">{{cite book|author1=William E. G. Thomas|author2=Norbert Senninger|title=Short Stay Surgery|url=https://books.google.com/books?id=98ayAtsiasMC&pg=PA136|date=1 February 2008|publisher=Springer Science & Business Media|isbn=978-3-540-69028-3|pages=136}}</ref>
==References== {{reflist}}
==External links== * [http://bioportal.bioontology.org/ontologies/SNOMEDCT/?p=classes&conceptid=http://purl.bioontology.org/ontology/SNOMEDCT/237400005&jump_to_nav=true Microdochectomy], Systematized Nomenclature of Medicine - Clinical Terms * [http://www.health.qld.gov.au/consent/documents/breast_02.pdf Breast Microdochotomy/Microdochectomy (patient consent form)], Queensland government
{{Breast procedures}}
Category:Breast surgery Category:Surgical removal procedures