Mammary duct ectasia

Aetiology and pathological features:

• The cause, as with many breast disorders, is an exaggeration of the normal cyclical changes – a wear and tear process
• The ducts adjacent to the nipple become dilated and engorged with breast secretions
• Secondary infection and a retroareolar abscess may form, but even if this does not happen, fibrosis can cause nipple retraction

History:

• The discharge can range from milky to dirty green
• Is often (but not always) bilateral
• Occasionally it is associated with pain, usually cyclical
• Acute infection causes pain and swelling

Physical findings:

• The breast may have features of lumpiness
• Nipple retraction:
• Caused by the chronic inflammation often associated with this condition
• Slit-like appearance
• May be confused with carcinoma

• In acute inflammation, an abscess forms which, if not treated at am early stage, discharges at the areolar margin:
• A small sinus (mammary fistula) then results which can be the focus of further attacks of inflammation

Investigation and management:

• If qualified by age, patients should have a mammogram to establish the general state of the breast
• Discharge is sent for cytological assessment
• Provided both the above investigations are normal, nothing further needs to be done other than to reassure the patient
• If a discharge is very troublesome, excision of the duct system (Hadfield’s operation) provides symptomatic relief

Abscess:

• An abscess in this condition is followed by a mammary fistula
• In consequence, after drainage there is not only often a persistent discharge but also the risk of recurrence
• The involved duct and its drainage area should be excised electively