Breast surgery • pathological discharge

One duct or all major ducts?

Tap through the clinical clues. First rule: exclude malignancy before choosing either operation.

Tap the upper or lower duct pathway to preview the likely operation.

Can discharge be reproduced from one identifiable duct?

Is disease localized, with preservation of other ducts desirable?

Diffuse duct ectasia, recurrent discharge, or culprit duct not isolatable?

MICRODOCHECTOMY

Excise the single affected duct

Best for uniductal, reproducible discharge, often from an intraductal papilloma or localized duct lesion. A lacrimal probe may identify the duct. It preserves the remaining ducts and better preserves future lactation.

Memory hook: Micro = one mapped duct.

HADFIELD

Excise all major subareolar ducts

Best for multiduct discharge, diffuse duct ectasia, recurrent symptoms, or when the responsible duct cannot be isolated. It provides definitive central duct clearance.

Counsel: may impair breastfeeding; risks include nipple ischemia/retraction, altered sensation, infection, and recurrence.

STOP

Neither—complete cancer work-up

Bloody discharge can reflect papilloma, ductal carcinoma in situ, or invasive cancer. Do not let a “duct ectasia” label bypass concordant clinical, imaging, and pathology assessment.

NEET-PG shortcut 🎯

Single duct → microdochectomy.
Multiple/major ducts → Hadfield.

Wording trap

Hadfield is total major duct excision. Microdochectomy is not a synonym: it removes one duct.

Quick check

Persistent bloody discharge from one clearly identified duct; imaging is benign. Best operation?

Localized, uniductal disease favors selective duct excision. Hadfield is for multiduct, diffuse, recurrent, or unlocalizable disease.

Duct Excision Decision Tree