Central duct excision is the surgical removal (excision) of all

lactiferous duct Lactiferous ducts are ducts that converge and form a Morphogenesis#Branching morphogenesis, branched system connecting the nipple to the lobules of the mammary gland. When lactogenesis occurs, under the influence of hormones, the breast milk, mil ...

under the

nipple The nipple is a raised region of tissue on the surface of the breast from which, in lactating females, breast milk, milk from the mammary gland leaves the body through the lactiferous ducts to Breastfeeding, nurse an infant. The milk can flow th ...

. The excision of a single duct is called

microdochectomy Microdochectomy is the surgical removal (excision) of a lactiferous duct. A mere incision of a mammary duct (without excision) is called ''microdochotomy''. Indication Microdochectomy is a standard treatment of in case there is nipple discharge w ...

, a mere incision of a mammary duct (without excision) is ''microdochotomy''.

Indication

Central duct excision is a standard treatment of in case there is

nipple discharge Nipple discharge is fluid from the nipple, with or without squeezing the breast. The discharge can be milky, clear, green, purulent, bloody, or faintly yellow. The consistency can be thick, thin, sticky, or watery. Nipple discharge may be nor ...

which stems from multiple ducts or cannot be traced back to a single duct. It is also indicated if there is bloody nipple discharge in patients beyond childbearing age. Duct excision may be indicated for the treatment of recurrent breast abscess and mastitis,, p. 1694 and the total removal of all ducts from behind the nipple has been recommended to avoid further recurrence. In particular if the patient wishes to preserve

breastfeeding Breastfeeding, also known as nursing, is the process where breast milk is fed to a child. Infants may suck the milk directly from the breast, or milk may be extracted with a Breast pump, pump and then fed to the infant. The World Health Orga ...

ability, the condition of the mammary duct system is investigated by means of galactography (ductography) or ductoscopy in order to determine whether the excision of a single duct (

) would be sufficient. Pre-operatively, also breast ultrasound and

mammogram Mammography (also called mastography; DICOM modality: MG) is the process of using low-energy X-rays (usually around 30 kVp) to examine the human breast for diagnosis and screening. The goal of mammography is the early detection of breast cancer ...

are performed to rule out other abnormalities of the breast.

Procedure

A circumareolar cut (following the circular line of the

areola The human areola (''areola mammae'', or ) is the pigmented area on the breast around the nipple. More generally, an areola is a small circular area on the Human body, body with a different histology from the surrounding Tissue (biology), tissue ...

) is made, the ducts are divided from the underside of the nipple, and the surrounding breast tissue is removed to a depth of 2–3 cm behind the nipple-areola complex.

Complications

Possible complications of the procedure include nipple tip

necrosis Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. The term "necrosis" came about in the mid-19th century and is commonly attributed to German pathologist Rudolf Virchow, who i ...

, in which case further surgery may become necessary to recreate the nipple. A further complication is altered sensation, shape, size and color of the nipple, including nipple inversion. Furthermore, infection or

hematoma A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillaries. A hematoma is ...

may occur. These risks are higher than they are for the

procedure. After all or most ducts are excised, breastfeeding is no longer possible.

References

{{Breast procedures Breast surgery Surgical removal procedures