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Breast Cancer

Subareolar rescetion

02/02/2009

Question:

After my first mamogram (6 months ago), they made me come back for a really big squish of my left breast. They said all was fine but come back in 6 months. Few days later, my right breast started having discharge - clear, was happening at night I noticed in the morning, till about 5 months. It then turn bloody. I went to my doctor who had me get another mamogram and ultra sound. Radioligists said all fine and suggested I get a ductogram due to bloody discharge. Their report stated I had a Benign. I already had an appointment with a Breast Surgeon and had a very hard time finding anyone who did ductograms. The Breast Surgeon suggested I get a Subareolar Rescetion and also stated no one does ductograms any more. I have never had any kids, so no breast feeding was ever done. From what I have read each surgeon is different but what is your opinion of not getting or getting a ductogram. When you get a Subareolar Rescetion do your ducts no longer work? What is the result of your nipple after having the surgrey. Do you see these scars? I have also read some studies that people did not opt for surgey. In Test group, two stopped bleeding and one was still bleeding. Do you have any more information if you opt not to get the surgey?

Answer:

Clear or bloody nipple discharge is most often caused by a benign lesion (intraductal papilloma), but can rarely be caused by cancer.  The risk of cancer increases with increasing age, but is usually only about 5%.  The standard therapy in my practice is subareolar resection.  I do not do ductograms, because I don't find that they change my management recommendations.  Usually, the incision is hidden at the edge of the areola, where the skin color changes.  The cosmetic result is usually excellent.  There is a small risk that the blood supply to the nipple can be injured, and that wound problems can occur, but that is pretty unusual.  After surgery, your ducts are disconnected, so they don't work.  If you are done with kids and breastfeeding, this is not a problem.  If you do want to breastfeed, the surgeon can try to find the one duct that is expressing fluid and remove only this duct, but that is often difficult to do, and not particularly advantageous unless you plan to breastfeed again in the future.  Since nipple discharge is usually caused by benign lesions in the duct, it's unlikely that anything really bad will happen if you choose not to have the surgery, but since cancer can be present, although rare, the surgery is generally what I recommend.

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Response by:

Doreen M Agnese, MD Doreen M Agnese, MD
Clinical Associate Professor of Surgery
College of Medicine
The Ohio State University