A 48-year-old woman presents with a bloody nipple discharge. Mammography is normal. Ultrasound shows a 4 mm intraductal lesion at 10 o'clock, 3 cm from the nipple. The most appropriate next surgical step after failed cytological diagnosis is:
- A Microdochectomy of the single discharging duct ✓
- B Central duct excision (Hadfield procedure)
- C Total duct excision (Devonshire procedure)
- D Vacuum-assisted biopsy of the intraductal lesion
Explanation
When a single duct is identified as the source of bloody nipple discharge and imaging localises a specific intraductal lesion, microdochectomy (excision of the single discharging duct) is the operation of choice, as it preserves remaining ducts and avoids nipple retraction seen with total duct excision. The Hadfield (central duct excision) procedure removes all major subareolar ducts and is appropriate for multiple-duct discharge or periductal mastitis, not a localised single lesion. Devonshire procedure is synonymous with total duct excision. Vacuum-assisted biopsy may be used but does not provide definitive treatment for a symptomatic lesion.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.