Microdochectomy is performed to manage nipple discharge that involves only a single duct. It is a simple outpatient procedure that can be carried out under either local or general anaesthesia. Prior to the surgery, the affected duct is identified through galactography, a procedure that investigates the ductal system of the breast and serves as a map of the ducts to locate the affected one. In addition, several examinations, including mammography and breast ultrasound, may be requested by the physician preoperatively.
At the operating theatre, gentle pressure is exerted on the nipple to identify the orifice or opening of the affected duct. A fine probe is carefully inserted as far as possible into the duct, making sure that it is not damaged or disrupted. The duct is then dilated and dye is injected into it, marking the duct.
The borders of the nipple are then traced and incised (circumareolar incision). The areolar skin is raised up to create a skin flap. The affected duct is gently dissected and freed off from the tissues surrounding it for approximately 5 cm. The duct is then transected and removed. Some surgeons may opt to insert a drain, which will be removed after several hours. Closure of the incision is accomplished using absorbable sutures.
Microdochectomy serves as both a diagnostic and a therapeutic procedure. The specimen collected is sent for biopsy to determine the cause of the nipple discharge. If only a single duct is involved, microdochectomy will result in the resolution of the nipple discharge. However, if multiple ducts are involved, a more extensive procedure, such as a subareolar resection or central duct excision, may be indicated.
The major benefit of performing a microdochectomy is the preservation of the patient’s ability to breastfeed. This advantage is ideal for young patients who are currently breastfeeding or who have plans of breastfeeding in the future.
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