Nipple Discharge Surgery

What is the cause of Nipple Discharge?

Nipple discharge is then name given to fluid leaking from one or multiple ducts of your nipple areola complex. Your breasts normally leak a minute amount of fluid that can’t really be detected. Occasionally there is excess in this fluid that it becomes abnormal.

Nipple discharge can occur due to a variety of reasons. Nipple discharge is rarely due to a cancer. Despite this cancers can occasionally present with a nipple discharge. The majority of nipple discharge is either due to a variation in normal physiology or due to another underlying medical problem that may or may not require treatment.

Below is a list of the various types of nipple discharge. The first 3 are usually a feature of normal breast pathology. Where as the last 4 types of discharge are usually indications for surgical intervention.

  • Clear (watery).
  • Milky.
  • Multi-coloured.
  • Purulent.
  • Yellow (serous).
  • Pink (serosanguineous).
  • Bloody (sanguineous).

The majority of reasons why a patient has nipple discharge that require surgical intervention are due to benign causes. These include the following:

  • 50% - Intraductal papilloma (benign growth within the duct).
  • 35% - Fibrocystic change (normal age related changes within the breast).
  • 5% - Breast Cancer.
  • <5% - Prolactinoma (pituitary tumour secreting prolactin stimulating a milky discharge).
  • <5% - Abscess.

What information is needed about your nipple discharge?

Below is a list of the information that will be asked of you when you present for your consultation. The aim of these questions is to determine most likely underlying cause and to determine the possible cancer risk.

  • Your menopause status.
  • Time the discharge has been present for.
  • Colour of the discharge.
  • How frequent does the discharge occur.
  • Spontaneous or cyclical (associated with menstrual period).
  • Single duct or multiple ducts involved.

In general terms new bloody discharge form a single duct in a post-menopausal women needs urgent investigation to the possible cancer risk. On the other hand a yellow/green discharge in a post menopausal women involving multiple ducts is usually duct ectasia and part of the normal ageing process of the breast.

What is a michrodochectomy?

A michrodochectomy is the removal of a single duct that is responsible for the nipple discharge.

When a single duct is causing the nipple discharge the most likely the result of a benign (non-cancerous) growth within the duct that blocks the normal secretions. The fluid builds up behind the growth and intermittently discharges. To correct this problem, only the duct with the growth needs to be removed. This will remove the abnormal duct, the growth and the stop the discharge.

The benefits of a michrodochectomy are that the majority of the nipple areola complex is left untouched. The ability to breast feed in the future should not be reduced significantly. Also the sensation in the nipple should be unaltered. The overall appearance of the nipple should be largely unchanged.

What is a total duct excision?

If the discharge involves multiple ducts or is not controlled with a single duct excision then the all the ducts under the nipple may need to be removed.

The downside of a total duct excision is the sensation of the nipple will be reduced. The nipple will be numb after the operation. The shape of the nipple may change, most likely being flatter than the opposite side and also having the possibility of being retracted (sunken).

In younger patients a total duct excision is not advised due to the inability to breast feed in the future if this surgery is performed. A michrodochectomy is usually offered in younger patients. In patients over the age of 50 the underlying process is more likely to involve multiple ducts and thus a total duct excision is more likely to be indicated.

What is involved in the surgery?

A michrodochectomy is normally performed under a general anaesthetic and is usually performed as a day procedure.

It is important that you don’t squeeze your nipple prior to the surgery. It is necessary to see the duct that the discharge is coming from while you are asleep so the correct duct can be removed.

Once asleep Dr. Green will express the discharge from the nipple and pass a small probe down he duct. This allows the correct duct to be identified.

A small incision around the edge of the areolar will be made. The duct with the probe in place is then removed and sent to the pathologist to determine the underlying cause.

The wound is closed with dissolving stitches and then covered with a waterproof dressing.

Are there any side effects or complications?

After the surgery there should be minimal discomfort. Any pain should be easily controlled with simple tablet analgesia.

A michrodochectomy is a commonly performed procedure with a low rate of complications. Most patients have very little discomfort from the surgery and have an uncomplicated recovery process.

Unfortunately in a very small number of people complications can occur. Most are minor but cause some additional discomfort.

Below is a list of some of complications that may be possible with surgery for nipple discharge.

  • Numbness – The skin under the nipple will be numb for some time after the surgery. Most sensation will return with a michrodochectomy, where as a total duct excision is likely to remain numb.
  • Deformity – Occasionally there can be excessive scarring resulting in deformity of the nipple.
  • Scarring – Prominent scaring can occur in some people. This is more pronounced in pigmented skin types.
  • Inability to breastfeed – A total duct excision completely removes the ducts under the nipple and will prevent any chance of future breastfeeding. A michrodochectomy usually preserves the majority of ducts allowing breast-feeding to occur.
  • Infection – Wound infections are uncommon and most can be treated with a simple course of oral antibiotics. Very rarely the infection can be more severe requiring admission to hospital and a second operation to treat the infection.
  • Nipple necrosis – Results when the blood supply to the nipple is disrupted. This causes the nipple to turn black and die. This is a severe but luckily very rare complication from a total duct excision. It occurs in less that 1-2% of cases.
  • Missed lesion (papilloma) – It is possible that a second duct is responsible for the discharge that is not initially identified. This may result in the causative duct and lesion not being removed in a single operation.