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Hadfield Procedure / Total Duct Excision

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Hadfield Procedure / Total Duct Excision www.drsoobrah.com Patient information leaflet 1 Hadfield Procedure / Total duct excision What is nipple discharge? Nipple discharge may be common for premenopausal women—especially milky discharge. This is usually due to normal hormonal changes within a woman’s body. It often occurs in both breasts. There are some specific types of nipple discharge that warrant closer evaluation: Bloody nipple discharge – If the discharge is bloody, a papilloma is suspected. This wart-like group inside the duct irritates the tissue, producing the reddish discharge. This can also be a symptom of breast cancer, so proper evaluation is recommended. Greenish nipple discharge – If the discharge is army green in colour, it can be a sign that there is a breast cyst underneath the nipple and areola area that is spontaneously draining. This can be further evaluated with breast imaging studies, such as ultrasound. Clear nipple discharge – Clear discharge can be a sign of abnormal cells (including cancer cells) within the breast. The risk of cancer is lower when there is discharge from both breasts. Bloodstained nipple discharge: About 5-10% of patients with bloodstained discharge will be found to have an underlying cancer. Most bloodstained discharges are due to papillomas [small noncancerous (benign) tumours that grows in a milk duct] or other benign conditions (anticoagulation drugs such as warfarin, aspirin, clopidogrel etc). What is a Hadfields procedure and what does this operation involve? A Hadfields procedure is an operation carried out to disconnect and remove part of the major nipple ducts. This will take approximately 30 minutes and is usually undertaken under a general anaesthetic. While you are asleep a cut (incision) is made around the areola (the darker area around the nipple). The ducts are disconnected from the back of the nipple. The wound is closed with stitches or glue [Figure 1 & 2]. The removed tissue will be sent for analysis to confirm a diagnosis. { Microdochectomy involves the removal of a single affected duct (the other milk ducts are not removed) – a woman can still breastfeed after this operation. } Figure 1 What are the benefits of this procedure? The operation will help to: Diagnose the cause of the problem and stop the nipple discharge. Prevent recurrent breast abscess formation. Correct nipple inversion (nipple goes in and will not come out easily) Treat persistent and troublesome galactorroea (milky nipple discharge) Treat a mammary duct fistula (ulcer near the nipple) needs to be removed. Page 1 of 3 Dr Ramawad Soobrah www.drsoobrah.com Patient information leaflet 2 What are the risks of this procedure? Most operations are straightforward; however as with any surgical procedure there is a small chance of side-effects or complications. Pain: Some people find that the breast aches for a little while after the operation. Simple painkillers (such as Paracetamol or Ibuprofen) should help. Bruising and bleeding: Bruising is common after surgery. It may be mild or moderate, but will gradually disappear on its own. Very occasionally a blood clot (haematoma) forms quickly following surgery and a second operation may be required to correct this. Nipple sensation: In some cases feeling and sensation around the nipple and areola area may be altered following surgery. Nipple necrosis (loss of nipple) - Necrosis of the nipple (part or all of the nipple dies because of a poor blood supply after the operation). This is a rare complication. Patients most at risk of this are those who have had several “nipple” operations. If this happens, the nipple will heal over with new skin in time. It may take several weeks or months to fully heal. For women having the operation for nipple discharge, this may return if not all of the affected duct or ducts have been removed. Sometimes fluid may fill the small space behind the nipple and this may leak out through the nipple. Infection: A wound infection can develop at any time until the wound has healed (which takes approximately 7 - 10 days). Any of the following symptoms could indicate a wound infection: The wound feels tender, swollen or warm to touch. Redness in the area. Discharge from the wound. Feeling generally unwell with fever. Figure 2 Page 2 of 3 Dr Ramawad Soobrah www.drsoobrah.com Patient information leaflet 3 What will happen after my operation? It is normal to experience some pain and discomfort after your operation and whilst the wound is healing. You will also find some moderate bruising around the area. You may take your normal painkillers to help reduce the pain. It is important that you rest for 48 hours following the operation. You should allow 2-5 days off work. You may need to stay off work longer than this, depending on the healing process. You should be able to gradually resume normal activities when you feel well enough. Avoid heavy lifting and frequent stretching at first Demo Movie Clip: http://www.youtube.com/watch?v=nwqyKvQ_mNk Author: Dr Ramawad Soobrah Date Created: March 2014 Page 3 of 3 Dr Ramawad Soobrah .
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