A 35-year-old woman presents with a spontaneous unilateral single-duct bloody nipple discharge. On ductoscopy, a 4mm intraductal lesion is found in the major lactiferous duct. Histopathology shows a papilloma with no atypia. The most appropriate surgical management is:
- A Microdochectomy (excision of the affected duct) ✓
- B Total mastectomy
- C Hadfield's operation (total duct excision)
- D Conservative management with annual mammography
Correct answer: A. Microdochectomy (excision of the affected duct)
Explanation
Solitary intraductal papilloma causing bloody nipple discharge is best treated by microdochectomy — excision of the single affected duct under methylene blue dye guidance. Hadfield's operation (total duct excision) is reserved for multiple papillomas, older women with complete breast-feeding, or periductal mastitis recurrence. Total mastectomy is not warranted for a benign solitary papilloma without atypia.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.