A 48-year-old woman reports intermittent blood-stained discharge from a single point on the right nipple. Examination reveals no lump, and mammography and ultrasound are normal. What is the most appropriate surgical procedure?
- A Total duct excision (Hadfield's operation)
- B Hockey stick incision drainage of the retroareolar space
- C Microdochectomy of the affected duct ✓
- D Central excision of a wedge of breast tissue including the nipple
Correct answer: C. Microdochectomy of the affected duct
Explanation
Single-duct blood-stained discharge in a woman of this age most often indicates an intraductal papilloma, and when imaging is negative the affected duct must be identified intraoperatively by probing or methylene blue injection and removed by microdochectomy. Total duct excision (Hadfield's operation) is reserved for multiple-duct discharge or diffuse duct ectasia, while preserving unaffected ducts maintains future lactation and nipple sensation.
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.