Microdochectomy and Total Duct Excision 

About Breast Ducts?

There are several ducts called lactiferous ducts in the breast. 

Approximately 12-15  lactiferous ducts form a branched system from the lobules of the mammary gland and converge onto the surface of the nipple.

Lactation occurs under the influence of hormones, and milk is moved from the glands using smooth muscle contractions along the ductal system to the tip of the nipple.

What is the Difference Between a Microdochectomy and a Total Duct Excision

Microdochectomy

Microdochectomy is the surgical removal (excision) of a specific lactiferous breast duct responsible for the abnormal discharge. It is suitable for younger women who wish to preserve the ability to breastfeed after surgery.

Total Duct Excision

Total duct excision involves the removal of all the significant ducts from behind the nipple. It is indicated for discharge from multiple ducts in the nipple and persistent discharge after a microdiscectomy. Some diseases affect all of the breast ducts.

Indications for a Microdochectomy and a Total Duct Excision

A procedure may be required for patients who:

• Have nipple discharge from multiple ducts,
• Display Inverted nipples and or
• Chronic infection beneath the nipples that affects the ducts

Nipple discharge may require surgery to remove the ducts behind the nipple to stop the discharge and to provide tissue to the pathologist to identify the cause of the discharge.

About Microdochectomy/Total Duct Excision Procedure

Both operations are usually performed as a day procedure under general anaesthesia.

They involve a small incision along the line between the brown area around your nipple (the areola) and the remaining skin of the breast (periareolar incision).

• In a Microdochectomy, after the specific lactiferous breast duct is isolated with a fine probe, the duct is removed without damaging the remaining ducts. This is different from a microdochotomy which involves an incision of a mammary duct only.
• Total duct excision involves the removal of all the major ducts from behind the nipple.

After the removal of the duct(s) the incision is closed. The procedure takes around 60 minutes.

The wound is closed with absorbable sutures, and a waterproof dressing is applied.The incised ducts are sent for diagnostic assessment.

When Do I Receive My Biopsy Results?

You will be seen one week after your surgery in the clinic to discuss your results and have a check-up.

Microdochectomy/Total Duct Excision Questions

Hospital Stay

Most patients go home on the day of surgery. It is recommended that you be accompanied home by a carer who will stay with you (or very close by) for the first 24 to 48 hours.



Wound Care & Dressing

The stitches are dissolvable, and the dressing is waterproof so that you can shower as normal. Please do not bathe or swim until it has been cleared by your surgeon.

After two weeks, your wounds should be healed, and you can remove your dressing. Typically no further dressings.

Return to Work

Depending on your surgery and job, you may need one week-off work. Most patients have their surgery on Friday and are back to work on Monday.

Post Op Driving

You need to be able to make an emergency stop safely. As the seatbelt crosses your chest you will need to wait a week before you can drive safely.

Gym & Exercise

A week before you start back at the gym as usual. You can do lower body exercises such as cycling and walk almost immediately. Listen to your body and if it hurts, stop and wait a few days before trying again. Avoid ‘breast bounce’ for four weeks.

Complications of Excisional Biopsies:

As with any surgery, a breast biopsy may involve certain risks and complications, including scarring, altered breast appearance, infection, poor healing and bleeding.

• Postoperative Pain: Most women will not have significant pain postoperatively. Paracetamol is recommended strictly and regular for 72 hours after the operation.
• Infection of the wound occurs in a very small percentage of cases, up to approximately 4% and is usually well treated with oral antibiotics.
• Bruising, bleeding, and haematomas are common after breast surgery and do not require a return to theatre. However, occasionally a return to the theatre to evacuate a haematoma is required. The patient should be aware of sudden swelling in the breast, which may indicate bleeding requiring further surgery.
• Scarring and changes to the size and shape of the breast can also occur. Hypertrophic or keloid scarring tends to be more common in patients with highly pigmented skin. Consideration is always given to the scar placement, and at all costs, every attempt should be made to ensure that scars are not placed in the décolletage. The best scars usually heal where the incision is made around the areola.

There can occasionally be a need for further surgery, particularly if cancer cells are found unexpectedly at operation.

There are also rare problems with the insertion of the guide wire itself, and this can occasionally cause some discomfort and bruising to the breast. Sometimes, more than one wire is required to be placed, and this may make patients feel faint. 

In some cases, when a hook wire is placed, the abnormality will not be found in the retrieved tissue. There are several reasons this can occur - in particular, the hook wire may move in the breast during the patient's transit from the radiology department to the operating suite. 

Some patients will feel tired and have postoperative nausea and vomiting after a general anaesthetic. Allergic reactions to anaesthetic drugs are very uncommon.