What you need to know about:

Microdochectomy

Fast Fact

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Recovery Period:

1 to 2 days

Permanence:

Permanent

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Time it takes:

20-30 minutes

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Anesthetize:

General anesthesia

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Overview of

Microdochectomy

in Thailand

Microdochectomy is a minor surgery involving the surgical removal of one of the breast ducts (also known as milk ducts).

The breast tissue is formed mainly of glandular tissues — the part responsible for milk production, fatty tissues; and connective tissues that support the other tissues and keep them in place.

After pregnancy, milk production through the glandular tissues is initiated, and a special pipeline system called milk ducts delivers the milk to the areola to provide smooth breastfeeding. There are around 12-15 ducts on each breast opening into the nipple.

Goals of

Microdochectomy

Microdochectomy is indicated in case there is abnormal nipple discharge involving only one duct. This is especially important for women who desire to preserve their ability to breastfeed.

In other cases, where there is a condition involving multiple or all of the breast ducts, a total duct excision surgery is performed where all breast ducts are removed. These cases involve:

patients experiencing abnormal secretions from more than one duct.
abscess of ducts repeated over a long period of time
patients with pointed inward nipples
cases with unresolved issues of nipple discharge or secretions after Microdochectomy.

Price of

Microdochectomy

Average Cost

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Pros and cons of

Microdochectomy

Pros

microdochectomy is considered as both a treatment and a diagnostic tool. It removes the duct causing the problem thereby treating the condition. The excised duct is then sent to the pathological lab for further examination, helping doctors to diagnose the disease causing the discharge problem and to exclude malignancy.
the incision line is performed around the areola to decrease the chance for scar formation.
a single duct removal keeps the chances up for breastfeeding specially for young patients who are planning for future pregnancy and breastfeeding.

Cons

as with any surgical procedures, some patients are at risk of surgery-related adverse effects such as: bruising, inflammation of the wound, pain, deficit in nipple sensation, poor esthetic outcome of the wound and inability to breastfeed.
consult your doctor before the surgery and consider all other alternatives.

How it works:

Microdochectomy

Microdochectomy is a simple surgery which is carried out under general or local anesthesia to provide you with complete comfort.

After sedation, the affected duct is injected with dye to be easily recognized from the surrounding tissue for easy and safe excision, then a small cut is made around the areola to provide exposure of the breast tissues.

Excision of the affected duct takes place and it is examined by a pathologist to identify the problem and exclude the possibility of a tumor development.

The incision is finally closed using self-resorbing sutures. If the biopsy found malignancy in the excised duct, a more extensive procedure may be required. Your doctor will advise you on the next step.

Preparation before

Microdochectomy

Pre - treatment

Before surgery, some tests may be recommended by your doctor. Some of them may be related to the surgical site or related to your general health.

Relating to the operation filed, your doctor may request a galactography (which is a procedure that provide mapping of the duct system of the affected breast), mammography or breast ultrasound.

General health-related tests may be performed if your physician decide to go with general anesthesia. For instance: complete blood count (CBC), chest imaging, and some tests related to the heart performance (electrocardiogram EKG).

Don’t forget to report any known history of medical allergies to your doctor. Follow your doctor’s instructions about the fasting hours before surgery (usually 6-8 hours).

Arrange a transportation back home after surgery as driving may not be a safe option.

Recovery after

Microdochectomy

Post - treatment

Once the surgery is finished, you will be transported to the recovery area to stay under surveillance for a short time. Your doctors will monitor your post-surgery recovery process and check that all your vital signs are stable, before allowing you to discharge from the hospital. Microdochectomy is a simple surgery so you may be released on the same day or maximum the following day.

The wound will be covered by a waterproof dressing; you can safely shower but make sure the area is kept moist free for few days.

Make sure to follow the post-treatment instructions closely such as no driving for 1 day, no lifting of heavy objects and no strenuous activities for a few weeks. Return to work when you feel ready (usually after 1-2 days).

You may feel uncomfortable with your wound for up to 2 weeks, this is normal. Consult your doctor immediately if you see any warning signs of infection.

Risks & side effects

Microdochectomy is a minor surgery that does not involve extensive risks or complications. In the rare event of post-surgery complications such as wound infection, it usually can be treated with antibiotics. Pain relief medications are sometimes prescribed by the doctor to alleviate post-surgery pain. Some patients may experience bruising but that should also go away on its own with time.

More serious side effects may also occur. There is risk of injury to the nerve during the procedure, which may lead to loss of sensation in nipple and consequently difficulty in breastfeeding. For some patients, improper healing at the surgery site may also give rise to an unpleasant esthetic outcome but this happens rarely.

FAQs:

Microdochectomy

What are the travel recommendations for this procedure?

In case you are traveling to another country for the procedure, make sure you inform your doctor about any regular medication you take. Anticoagulant drugs must be ceased before surgery as it increases the risk of bleeding.

Make travel arrangements to stay at least 2 weeks for complete recovery and follow-up.

Your doctor must assess the recovery of your surgical site to give you the green light for traveling. If everything goes well, you will receive a “Fit to Fly" certificate from your doctor for your return trip.
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What are the causes for nipple discharge?

Usually nipple discharge is a simple condition caused by factors such as aging-related enlargement of the milk duct (duct ectasia), swelling or lump in the duct (intraductal papilloma) or even breast abscess. In few cases, discharge may be a sign of malignant condition and in this case it is usually a bloody discharge which requires a more complicated line of treatment and follow-up.

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How can we diagnose that you need a microdochectomy surgery?

Multiple imaging techniques may be used to collect sufficient amount of information. The doctor can then give a proper diagnosis and propose a suitable treatment plan for you.

The imaging techniques utilized may include mammography, breast ultrasound and galactography. In a galactography, X-ray is used to create a full mapping of the duct system in the breast.

Based on the gathered information, Microdochectomy is the treatment of choice for tissue conservation purpose when the discharge involves a single duct.

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