Central duct excision

Central duct excision is a surgical procedure primarily used in the treatment of benign breast conditions, particularly those involving the milk ducts such as solitary intraductal papilloma, duct ectasia, and subareolar abscesses. This procedure involves the removal of the central milk ducts of the breast, which are located beneath the nipple and the areola. Central duct excision is often considered when there is nipple discharge that is bloody or persistent, especially when it is associated with a mass or abnormal imaging findings.

Indications

Central duct excision is indicated for patients experiencing pathological nipple discharge, which is often bloody or serous, and originates from a single duct. This condition can be symptomatic of various underlying issues, including intraductal papilloma, duct ectasia, or even breast cancer in rare cases. The procedure is also indicated for recurrent subareolar abscesses that do not respond to other treatments. It is important to conduct a thorough diagnostic evaluation, including mammography and ultrasound, to rule out malignancy before proceeding with a central duct excision.

Procedure

The central duct excision procedure is typically performed under general anesthesia. A small incision is made around the edge of the areola or directly over the affected duct. The surgeon then identifies and excises the affected ducts, removing them completely to prevent recurrence of symptoms. Care is taken to preserve the surrounding tissue and maintain the aesthetic appearance of the breast. The excised tissue is usually sent to a pathology laboratory for examination to ensure that no malignant cells are present.

Postoperative Care

After the procedure, patients may experience some pain, swelling, and bruising, which usually subsides within a few weeks. It is important to follow the surgeon's postoperative care instructions, which may include wearing a supportive bra and avoiding strenuous activities. Patients are typically advised to monitor the surgical site for signs of infection or complications. Follow-up appointments are crucial to assess healing and discuss the pathology report.

Risks and Complications

As with any surgical procedure, central duct excision carries some risks, including infection, bleeding, and scarring. There is also a risk of altered nipple sensation or, in rare cases, damage to the nipple-areola complex. However, these complications are relatively uncommon, and the procedure is generally considered safe and effective for the appropriate indications.

Conclusion

Central duct excision is a valuable surgical option for patients with certain benign breast conditions that cause nipple discharge or recurrent abscesses. By removing the affected ducts, this procedure can alleviate symptoms and provide tissue for pathological examination, offering reassurance to patients. As with any medical intervention, a thorough evaluation and discussion of the risks and benefits with a qualified healthcare provider are essential before proceeding.