Microdochectomy

MICRODOCHECTOMY, THE EASY WAY

The diagnosis of single-duct nipple discharge has become more accurate following galactography [1] and smear cytology [2] but microdochectomy is still the accepted way of treating and establishing a final diagnosis for this condition [3]. A reliable, minimally traumatic method is described for the precise cannulation of the discharging duct which is a prerequisite prior to its accurate excision.

The operation is performed under general anaesthesia and the relevant duct is identified by a gentle squeeze of the breast. Lacrimal probes are most commonly inserted into the discharging duct [3, 4] prior to excision but we utilise the introducer from a 22 gauge spinal needle ( Yale®Spinal 22GA 3.50IN, 0.7x 90 mm ).

The introducer of the spinal needle is advanced into the lactiferous duct with a rotating motion holding it gently between thumb and index finger.

A small, circumareolar incision is placed within the nipple-areolar complex and the isolated duct is dissected free and excised with a cone of underlying breast tissue. The excised tissue is sent for histological evaluation. The skin is approximated with 3/0, subcuticular Vicryl sutures.

Lacrimal probes are blunt ended whereas other Teflon catheters [5, 6] which are occasionally used for duct cannulation are sharp ended. Both carry the potential to traumatise and perforate the offending ductal system. The introducer of the Yale® Spinal needle has the advantage of high flexibility with a non cutting point. It can usually be introduce with minimal pressure, reducing the risk of creating a false tract.

1. Ciatto S, Bravetti P, Berni D, Catarzi S and Bianchi S: The role of galactography in the detection of breast cancer. Tumori 1988;74:177-181
2. Ishii Y, Fujii M, Wakabayashi T et al. : Cytology of nipple discharge with a cell concentration method - comparative study with direct smear method. J Jpn Soc Clin Cytol 1989;28:389-393
3. Locker AP, Galea MH, Ellis IO, Holliday HW, Elston CW, Blomey RW: Microdochectomy for single-duct discharge from the nipple. Br J Surg 1988;75(7):700-701
4. Welch M, Durrans D, Gonzalez J, Daya H, Owen AH: Microdochectomy for discharge from a single lactiferous duct. Br J Surg 1990;77(11):1213-1214
5. Tan WTL, Lim TC: Transareolar dye-injection microdochectomy. The American Surgeon 1992;58(7):404-408
6. Rimbach S, Wallwiener D, Fein A, v.Fournier D, Bastert G: Experimental microendoscopy of the milk duct system (ductoscopy). Zentral Gynaekol 1995;117:198-203

Fassiadis N, Smedley FH
Department of General Surgery, Bromley Hospital, Cromwell Avenue, Kent, BR2 9AJ

Corresponding author: Nicholas Fassiadis MRCS (Ed)
Specialist Registrar South East London Rotation
94 Dairymanswalk, Guildford GU4 7FF