Mammary Duct Ectasia: Bilateral vs. Unilateral Presentation
Mammary duct ectasia is typically unilateral, though it can present bilaterally in some cases. 1, 2
Clinical Presentation of Mammary Duct Ectasia
- Duct ectasia is characterized by dilation of the mammary ducts with chronic inflammation and fibrosis 3
- It commonly presents as noncyclical breast pain, which is usually unilateral and more focal than cyclical mastalgia 1, 2
- The pain is often described as an exquisite continuous burning sensation, typically located behind the nipple with a hypersensitive breast 1
- This condition is frequently associated with heavy smoking 1, 2
- Mammography may show duct ectasia or secretory calcifications at the site of pain 1
Epidemiology and Distribution
- Duct ectasia accounts for 17-36% of cases of pathologic nipple discharge 1
- It most commonly affects women in their fourth decade of life 1
- While primarily unilateral, studies have documented cases of bilateral presentation 4
- A case-control study of 236 females found that duct ectasia is more common in overweight and obese females, married women, and those with a history of lactation 4
Diagnostic Features
- Nipple discharge associated with duct ectasia may be spontaneous, unilateral, and from a single duct 3
- The discharge can be clear, serous, sanguineous, or serosanguineous 3
- When bilateral, the discharge is typically from multiple ducts and may be white, green, yellow, or clear in color 5
- Twenty-five percent of patients with noncyclical breast pain are reported to have duct ectasia with periductal inflammation 1
Clinical Course and Management
- Noncyclical mastalgia due to duct ectasia tends to be of shorter duration than cyclical mastalgia, with spontaneous resolution occurring in up to 50% of patients 1
- Most cases of noncyclic mastalgia do not respond to hormonal manipulation 1
- For symptomatic cases with mild symptoms, conservative management with reassurance is a treatment option 3
- Surgical options include microdochectomy or cone excision of major ducts for persistent symptomatic cases 6
Important Considerations
- While duct ectasia is benign, pathologic nipple discharge should be evaluated thoroughly, especially in older women, as it can be associated with underlying malignancy in 5-21% of cases 3
- Failing to evaluate pathologic nipple discharge in menopausal women can lead to increased risk of missing a malignancy 3
- Rare cases of simultaneous duct ectasia in both accessory breast tissue and normal breast tissue have been reported 6