Key principles
• Typically performed for multi-duct discharge (duct ectasia) or single duct discharge in older (>50) patient • Aim to disconnect/remove all ducts behind the nipple and to exclude associated malignancy
I perform a total duct excision by making a circumareolar incision and removing a 2cm disc of subareolar tissue to remove the major lactiferous ducts and sinuses.
Operation Details
• Perform under GA. No antibiotics. Supine • Circumareolar incision (no more than 3/5 circumference areola) • Dissect ducts off nipple areola complex (often use scalpel) • Remove ducts with conical wedge of tissue including major ducts and sinuses. Typically, 1- 2cm • Orientate specimen • Purse string subcutaneous tissue. Close skin 4/0 monocryl
Post-operative complications
• Need to tell patient will be unable to lactate • Nipple necrosis • Altered sensation • Bleeding • Infection • Nipple inversion / Poor cosmesis
Specific post-operative care
• Clinic 2 weeks for review of histology