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surgery for nipple problems

Nipple discharge is a common problem,

but only rarely requires an operation.

The most common reason for recommending an operation is when there is clear or blood-stained discharge from a single duct on one side. In most cases, this is caused by a benign lesion called an intraduct papilloma, but it can very rarely be caused by a small cancer. For this reason, excision of the affected duct is usually recommended. This provides a definite diagnosis, and also cures the discharge.

Microdochectomy
The operation to remove a single duct is called a microdochectomy or a single duct excision. It is done as a day case under a short general anaesthetic. When you are asleep, the surgeon identifies the affected duct. An incision is made around the nipple, and this duct is taken out, along with some of the glandular tissue attached to it. The incision is then closed. There is no change to the cosmetic appearance of your breast, and the sensation and function of your nipple is not normally affected.

Central duct excision
Sometimes surgery to remove all of the ducts from behind the nipple is recommended. This may be because you have very profuse discharge which is troublesome, or because you are having problems with recurrent infections. This operation is called a central duct excision (it may also be called a major duct excision or Hadfield's procedure). This is a day case procedure requiring a short general anaesthetic. The incision is the same as for a microdochectomy. The milk ducts are divided behind the nipple and a short segment excised. This will not affect the appearance of your breast. There is a small risk of loss of sensation to the nipple and, as the ducts have been divided, breast feeding will not be possible.

Nipple biopsy
Occasionally, a biopsy of the nipple is required. This can be done under a local anaesthetic and normally does not need to be done in an operating theatre. The reason for needing a biopsy is normally because there is a rash on the nipple and Paget's disease needs to be excluded.

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