A 25 year old female complaints of discharge of blood from a single duct in her breast. The most appropriate treatment is
Discharges from the nipple Discharge can occur from one or more lactiferous ducts. Management depends on the presence of blood in the discharge or discharge from a single duct. Treatment Treatment must firstly be to exclude a carcinoma by occult blood test and cytology. Simple reassurance may then be sufficient but, if the discharge is proving intolerable, an operation to remove the affected duct or ducts can be performed (microdochectomy). MICRODOCHECTOMY It is impoant not to express the blood before the operation as it may then be difficult to identify the duct in theatre. A lacrimal probe or length of stiff nylon suture is inseed into the duct from which the discharge is emerging. A tennis racquet incision can be made to encompass the entire duct or a periareolar incision used and the nipple flap dissected to reach the duct. The duct is then excised. A papilloma is nearly always situated within 4-5cm of the nipple orifice. Ductoscopy (inspection of the internal structure of the duct system) using microendoscopes is technically feasible but generally disappointing. The affected duct may not be visualised and biopsy systems are currently rudimentary. Ref: Bailey and love 27th edition Pg no : 864, 865
Radical excision
Microdochectomy
Radical mastectomy
Biopsy to rule out carcinoma
Endocrinology and breast