Microdochectomy: Anatomical Location and Clinical Application
Microdochectomy is performed in the breast, specifically targeting individual mammary ducts that originate at the nipple and extend into the breast parenchyma, most commonly for evaluation and treatment of pathological single-duct nipple discharge. 1, 2, 3
Anatomical Site and Surgical Access
The procedure is performed through a periareolar or transareolar incision at the nipple-areolar complex, allowing direct access to the affected mammary duct system 3
The surgical field extends from the nipple orifice along the involved duct into the subareolar breast tissue, typically removing 2-3 cm of the ductal system where intraductal lesions are most commonly located 1, 3
Transareolar dye-injection technique can be used to precisely identify and trace the affected duct from its nipple orifice through the breast parenchyma, ensuring complete excision of the pathological duct while preserving surrounding normal breast tissue 3
Primary Clinical Indications
Microdochectomy is the standard surgical approach for patients presenting with pathological single-duct nipple discharge (bloody or serosanguinous) when imaging and cytology are normal or benign 2, 4
The procedure serves both diagnostic and therapeutic purposes, as it provides definitive histopathological diagnosis while simultaneously treating the symptomatic discharge 2, 3
Underlying pathology is most commonly benign intraductal papillomas (48.7% of cases), though malignancy can be present in approximately 10% of cases despite normal imaging 2, 4
Important Clinical Context
Pre-operative imaging may fail to detect underlying malignancy in patients with single-duct discharge - mammography was unreliable in one series, detecting only 2 of 15 malignant cases 4
Nipple discharge cytology demonstrates limited sensitivity, being helpful in only 67% of cases with underlying malignancy 4
Modern ductoscopy-assisted microdochectomy allows direct visualization and targeted biopsy of intraductal lesions, potentially reducing the extent of tissue excision compared to traditional blind microdochectomy 1, 5
Symptomatic relief is achieved in 98% of patients with benign pathology, with minimal recurrence rates 2
Critical Distinction from Other Breast Procedures
Microdochectomy differs fundamentally from the wire-localized excisional biopsies described for DCIS and other breast lesions 6, 7. While wire localization procedures target nonpalpable mammographic abnormalities throughout the breast parenchyma using stereotactic or ultrasound guidance, microdochectomy specifically addresses the ductal system accessible through the nipple for discharge-related pathology.