Key principles
• Single duct discharge management • Requires duct identification and localisation
Microdochectomy is the directed excision of a discharging duct and its extension into the breast tissue
Specific preoperative preparation
• Ensure patient does not express nipple prior to operation • Mark appropriate side • Discuss options with patient if duct cannot be located → ?Proceed to TDE
Operation Details
• Position supine with arms of side of microdochectomy abducted to 80degrees • Prep and square drape breast • Pre incision o Express to establish position of discharging duct o Cannulate duct to lacrimal probe and secure in place • Circumareolar incision • Key steps o Elevate thick flap medially under the nipple o Locate probe o Dissect deeper along probe 2-3cm, or to encompass known intra-ductal lesion o Follow probe back to nipple and ligate duct close to nipple o Skin closure deep dermal 3/0 vicryl and 3/0 SC monocryl to skin
Intraoperative complications & challenges
• Unable to locate offending duct o This should have been discussed with patient prior - Older/Post-children → Consider procceding to TDE - Younger/Children → Don’t proceed and re-discuss post op
Post-operative complications
• Early o Haematoma o Seroma (uncommon) o Infection o Wound dehiscence o Skin flap necrosis (rare if not TDE) • Late o Scarring/cosmesis