Total Duct Excision

[theartofhappiness]

Anyone had one? What's the recovery like? I'm having one in a few weeks so would welcome any anecdotes/advice. Pre or post op.

Anyone? 🙏🏻

No experience, sorry. Happy to bump you, though.

Good luck. I wish you a good treatment.

Hi @theartofhappiness I haven't had a total duct excision but I have had a breast/nipple surgery to remove an intraductal papilloma (basically a growth in the milk duct causing nipple discharge). I think my surgery was a microdochectomy (removing a single milk duct).

I don't know how much different the operation is, but from looking at the NHS document linked below the total duct excision seems pretty similar to the microdochectomy. For mine, the surgeon explained she would cut around half of my areola area and remove the problem duct. I still have a small scar that goes halfway around the areola but it's not that noticeable because it's around the natural line of the areola in the first place.

The hospital will no doubt give you all the instructions, but from what I remember I couldn't eat or drink the from midnight before the surgery because it's a general anaesthetic. I also had to be naked under the surgical gown which I was a bit disconcerted by since it was just the nipple, but I think that's maybe standard for general anaesthetic.

For post-surgical recovery I had the usual resting instructions for post general anaesthetic, and not to exert myself or lift anything heavy. But there were no issues around moving my arms. I live by myself and didn't need any help except for the requirement to have someone collect me from the hospital. It was a day surgery. The stitches were localised to the nipple area and didn't affect the rest of my breast. When the surgeon followed up with me a couple of days later she told me I should be showering properly by that point already! I was worried to get the stitches wet. I followed all the instructions and it worked out fine.

I was anxious about it beforehand, but the surgery went well for me and I haven't had any problems since with nipple discharge. There had been blood in the discharge which is what prompted the surgery. The surgery healed fine but I have occasionally had tenderness in the nipple area a couple of years later, which I think may be hormonal/perimenopausal and was combined with breast tenderness in general.

I am in Canada (although I am British so know the NHS) so things might be a bit different, but from the NHS document it looks very similar.

https://www.swbh.nhs.uk/wp-content/uploads/2012/07/Breast-duct-excision-ML38861.pdf

Hope that helps a bit! Let me know if you have any questions and I'll see if I can help :)

@Penelopeandherpitstop thank you so much for your reply, detailed and reassuring, appreciate you taking the time to do that.
I'm nervous, never had any surgery under general anaesthetic 🫤

What Penelope said! I had all the ducts removed, for the same reason , and the process and recovery seems identical - UK, NHS. I was much woozier after the general anaesthetic than I expected though - I felt very knocked out for a couple of days, much more so than after my CSection (which was a spinal block but obviously a much bigger incision.)

Can barely see anything now. Breast looked a little like Vesuvius for a while, but gradually refilled with fat and evened out. Barely any scar

@angelinawasrobbed thanks, I was wondering about what sort of tissue volume would be removed and whether it would be noticeable.
I could only find one other post on MN about this operation and someone mentioned nipple collapse and their surgeon putting a stitch behind the nipple for support? My surgeon hasn't mentioned that he has just advised on a risk of lack of sensation and that there is a small chance of nipple loss.

@Penelopeandherpitstop did they know yours was an intraductal papilloma before the surgery or did you find out afterwards?

Mines a nipple discharge one, dark green/black but the surgery is diagnostic so I'm also a bit worried about the results as had a load of inconclusive tests.

@angelinawasrobbed just noticed you said you had an intraductal papilloma the same as @Penelopeandherpitstop, if you wouldn't mind could you answer the above question too?

Worrying about it all x

Basically, I was dripping bright red blood from my nipple. gp referred me to the local breast centre and I had an ultrasound and two mammograms while there, and the conclusion was that I had a papilloma, and that the duct would be excised. In fact , all the ducts were taken ion the day because more papillomas
were
found

my surgeon mentioned the slight risk of nipple loss, but not nipple
collapse - but then , she wasn’t expecting g to remove so
much tissue. As I said above, the nipple was sunken to start with but did fill out again. I do t k ow if there was a supporting stitch. You can barely tell now.

@theartofhappiness Like @angelinawasrobbed I'm pretty sure that from the mammogram and ultrasound the surgeon thought mine was most likely an intraductal papilloma before the surgery although she couldn't know for sure until the surgery. The discharge was clear for a while, then yellow and then had blood in it, although not bright red.

That sounds stressful that the tests have been inconclusive - I hope the surgery gives you some more concrete info about what's going on

The uncertainty of what the nipple and breast might look like after the surgery is stressful as well! But that does sound reassuring from Angelina about the recovery of breast shape and filling in after a total duct excision, even when it looks bad after the operation.

It was my first general anaesthetic too so I was worried about that. I told the anaesthetist that I was nervous the anaesthetic wouldn't work on me, which I knew was not very rational! But she was very reassuring and not dismissive of my questions. Anaesthetic is definitely a weird experience. After the initial recovery bit in the hospital I felt better and I think had a bit of adrenaline and was quite talkative with my friend who picked me up (I was very surprised by that) until I got home and was really fatigued and knocked out.

I hope your operation goes well and sending you good wishes for your recovery!

Thanks both! I'm nervous about the GA, but feel you have helped me in terms of what to expect with the operation and recovery. Appreciate the replies x

Good Luck!

Hello @angelinawasrobbedI had the surgery 3 weeks ago. My follow up is in another 3 weeks. From the outside it is healing well, bruising has gone but it is still very sore and tender to the touch over the nipple area. Just wondering if it is normal to still be so sore after this period of time and how long this lasts 😕 thanks x

I think so OP - but it is hard to remember. I was incredibly careful of it , and it was more painful than my Caesarian I remember thinking. But exactly how long that lasted I can’t now pinpoint.

@angelinawasrobbedI actually had that same thought yesterday about c-section, don't remember this much tenderness. Thanks for the reply x

I am having this surgery (with additional margins) this week. Would anyone mind sharing how long they needed off work? I haven’t been given much guidance on this and online it seems to say anything from 3 days to 3 weeks so I’m not sure what to expect!

My surgery is diagnostic and follow up isn’t booked until 3 weeks afterwards. I think I’m going to be full of worry.

Thank you.