A 49-year-old woman reports blood-stained discharge from a single duct orifice of the right nipple for three months. There is no palpable lump, mammogram is unremarkable, and discharge cytology shows no malignant cells. What is the most appropriate surgical management?

• A Total duct excision (Hadfield procedure)
• B Microdochectomy of the affected duct ✓
• C Simple mastectomy
• D Reassurance and annual review without intervention

Explanation

Single-duct blood-stained discharge in a woman of this age most often arises from an intraduct papilloma. Because the culprit duct can be identified preoperatively (by discharging it in theatre or by ductoscopy/guidewire), microdochectomy removes the diseased duct while preserving lactation and cosmesis. Total (Hadfield) duct excision is reserved for multiple duct discharge or when the duct cannot be identified. Reassurance alone is inappropriate for persistent single-duct bleeding until pathology is excluded.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.