Breast duct excision Tangohanga pū

Most women have 12 to 15 ducts in each breast. These carry milk from your milk glands to your nipple when you are breastfeeding. Sometimes a duct can become diseased and need to be removed in an operation called a duct excision.

The most common reason for this is an intraductal papilloma, which is a non-cancerous, wart-like growth in a duct. It can cause a watery or bloody discharge from your nipple. It is also sometimes called ductal papilloma, or papilloma of the breast.

If you have an intraductal papilloma, your healthcare provider will refer you to a breast specialist to decide what type of treatment you need. They will usually recommend having the duct removed because there is a small chance the growth can develop into cancer.

You will need a general anaesthetic (where you are put to sleep) for your duct excision.

A small cut is made around your areola (area around your nipple). The surgeon will remove the duct and any growth from underneath your nipple. This procedure is called a microdochectomy.

Sometimes the surgeon will need to remove all the ducts behind your nipple — this is called a total duct excision or central duct excision.

If you have not yet had children, you will usually be offered a microdochectomy. This is to reduce potential problems if you breastfeed in the future.

Depending on where the papilloma is, a specialist doctor called a radiologist can sometimes remove it using special needles guided by ultrasound.

You will most likely be able to go home on the day of your surgery. Depending on your surgery and job, you may need a few days to one week off work.

You can do lower body exercises such as cycling and walking almost immediately after your surgery, so long as this does not cause discomfort or strain in your chest area. You should avoid heavy lifting, and activities that cause your breasts to 'bounce,' for 4 weeks.

Breast biopsy

Your surgeon may decide to send the duct or ducts that have been removed to a lab to be examined.

They will discuss the results of this in your follow up appointment.

Scarring

Talk to your surgeon about how they will operate and what scars you will have afterwards. At first the scars will be narrow red lines, but they are likely to fade over 6 months to a year. A few people get raised, red, and thickened scars (called keloid or hypertrophic scars). Tell your surgeon if you have had this type of scar before.

Nipple changes

Some women will notice:

• a loss of sensation in their nipple
• the shape of their nipple has changed.

Very rarely, you can lose the nipple. This happens in less than 1% of cases and is more likely in women who smoke. You should give up smoking for at least 3 months before surgery to minimise the risk.

General surgical risks

As with all surgery, there is a small risk of:

• bleeding
• infection
• a reaction to the anaesthesia.

Risks of anaesthesia

You will be invited to attend a pre-admission clinic before your surgery. You can discuss any concerns then.