Breast Duct Surgery Program

Breast duct surgery is a specialized procedure used to treat structural, inflammatory, and abnormal cell growth (neoplastic) disorders affecting the lactiferous ducts—the delicate network of tubes that carry milk from the mammary lobules to the nipple. These ducts are an essential part of the breast’s glandular system and are influenced by hormones such as estrogen, progesterone, and prolactin, which regulate their development, function, and response to changes in the body.

Although the primary role of breast ducts is to transport milk during lactation, they also play a crucial role in overall breast health. The lining of the ducts (epithelium) is sensitive to hormonal shifts, inflammation, and cellular changes, making it vulnerable to conditions that can disrupt its function. These disruptions may lead to persistent nipple discharge, localized inflammation, blockages, or abnormal cell growth, which often require medical evaluation and, in some cases, surgical intervention.

Why Cuba

In Cuba, breast duct surgeries are meticulously planned, ensuring optimal patient outcomes while preserving breast function and aesthetics. Given the breast ducts’ essential role in both lactation and breast health, Cuban surgical teams conduct comprehensive preoperative evaluations, including detailed imaging and pathology assessments, to develop personalized treatment plans tailored to each patient’s condition.

Cuba offers both traditional open surgeries and minimally invasive techniques depending on the severity and nature of the ductal disease. Postoperative care is carefully managed to ensure optimal healing, prevent complications, and support long-term breast health. With a strong emphasis on patient-centered care, Cuban medical facilities provide thorough follow-up monitoring, pathology reviews, and post-surgical guidance, ensuring that individuals undergoing breast duct surgery receive the highest standard of medical care to promote long-term well-being and breast health preservation.

Importance of Breast Ducts

The breast ductal system is an intricate network of milk-producing glands (lobules) and ducts that transport milk to the nipple during lactation. Beyond their role in breastfeeding, the ducts are highly sensitive to hormonal fluctuations, making them susceptible to benign and malignant changes over time.

• They are the most common site of breast pathology, including benign tumours, inflammatory conditions, and ductal carcinoma.
• Ductal carcinoma in situ (DCIS), a non-invasive form of breast cancer, originates in the milk ducts.
• Persistent nipple discharge or breast infections often stem from ductal abnormalities.

Conditions That Require Breast Duct Surgery

Breast duct surgery is indicated for both benign and malignant conditions affecting the ductal system. These conditions are classified into infectious, inflammatory, neoplastic (tumours), and structural disorders.

• Benign Ductal Conditions (Non-Cancerous)
  • Duct Ectasia: Widening and thickening of the ducts, often causing nipple discharge and inflammation.
  • Intraductal Papilloma: A benign wart-like growth within a milk duct, leading to bloody or clear nipple discharge.
  • Chronic Ductal Infections or Abscesses: Persistent infections resistant to antibiotics may require surgical drainage or duct removal.

• Precancerous and Malignant Ductal Conditions
  • Atypical Ductal Hyperplasia (ADH): A precancerous change in the duct lining, increasing breast cancer risk.
  • Ductal Carcinoma in Situ (DCIS): A non-invasive breast cancer confined to the milk ducts, often requiring surgical removal.
  • Invasive Ductal Carcinoma (IDC): The most common form of breast cancer, which originates in the ducts and spreads beyond.

Causes of Breast Duct Disorders

Breast duct conditions arise from various factors, including:

• Hormonal fluctuations (estrogen and progesterone imbalances)
• Aging and postmenopausal changes (leading to duct ectasia)
• Ductal infections (bacterial or inflammatory conditions)
• Genetic predisposition (BRCA1/BRCA2 mutations in ductal carcinoma)
• Ductal trauma or injury (can lead to scarring and blockages)

Identifying the cause of ductal abnormalities is crucial for determining whether surgical intervention is necessary.

Symptoms of Breast Duct Disorders

Patients with breast duct disorders may experience a variety of symptoms, including:

• Nipple Discharge: Spontaneous or persistent discharge that may be clear, bloody, milky, or yellowish-green.
• Breast Pain or Tenderness: Especially in cases of inflammation, infection, or ductal blockages.
• Lump or Thickening Near the Nipple: Caused by papillomas, ectasia, or ductal carcinomas.
• Inverted or Retraction of the Nipple: A potential sign of underlying ductal pathology.
• Localized Breast Swelling and Redness: Indicating infection or inflammation of the ducts.

Early detection of these symptoms is essential for proper diagnosis and management.

Pre-Surgical Diagnosis

Before breast duct surgery is recommended, physicians conduct a detailed diagnostic assessment to confirm the presence, severity, and nature of the ductal condition. This evaluation helps determine whether surgical intervention is necessary and, if so, which surgical technique would be most appropriate.

• Clinical Breast Examination (CBE)
  • Palpation of breast tissue to assess lumps, tenderness, or skin changes.
  • Nipple assessment for discharge (spontaneous or provoked), retraction, or visible abnormalities.
  • Evaluation of lymph nodes in the axillary (underarm) and supraclavicular (above the collarbone) regions to check for possible cancer spread or infection.

• Mammography
  • Identifies microcalcifications, which may indicate ductal carcinoma in situ (DCIS) or other precancerous changes.
  • Detects structural abnormalities in the ducts, such as ductal thickening, asymmetry, or abnormal densities.
• Breast Ultrasound
  • Helps distinguish between cystic (fluid-filled) and solid ductal masses, guiding further evaluation.
  • Assists in detecting dilated or blocked milk ducts, which may be seen in duct ectasia or intraductal papillomas.
• Breast MRI (Magnetic Resonance Imaging)
  • Provides detailed, high-resolution imaging of breast ducts, particularly in dense breast tissue or in cases where mammography results are inconclusive.
  • Helps identify small or multifocal lesions that might not be visible on a mammogram or ultrasound.

• Biopsy (Fine Needle Aspiration or Core Needle Biopsy)
  • Fine Needle Aspiration (FNA) is used for fluid-filled cystic lesions, helping rule out infection or malignancy.
  • Core Needle Biopsy (CNB) removes tissue samples from a solid mass to differentiate benign growths (papillomas, fibroadenomas) from malignant tumors.
  • A surgical (excisional) biopsy may be required if needle biopsy results are inconclusive or if a larger tissue sample is needed for pathological assessment.

Breast Duct Surgery Procedures  

If the diagnostic findings suggest persistent abnormal growths, high-risk lesions, or malignancy, surgery is often the next step to ensure effective treatment and disease management.

Surgical intervention is recommended when:

• Nipple discharge is spontaneous, persistent, or bloody.
• A ductal mass or thickening is detected on imaging.
• Biopsy confirms precancerous or malignant changes.
• Antibiotic-resistant infections or chronic abscesses occur.
• Recurrent pain or discomfort significantly affects quality of life.

The choice of surgical procedure depends on the extent of the ductal condition and the need for tissue removal.

Microdochectomy (Single Duct Removal)

• Performed when only one duct is affected by persistent nipple discharge, intraductal papillomas, or localized ductal abnormalities.
• The procedure is performed by making a small incision around the nipple and the affected duct is removed while preserving surrounding structures.

• This is a minimally invasive procedure performed under local or general anesthesia.

Total Duct Excision (Hadfield’s Procedure)

• This procedure is performed when multiple ducts are involved, particularly in chronic infections, duct ectasia, persistent discharge or high-risk ductal abnormalities.

• An incision around the nipple allows access to the ductal system to remove all major lactiferous ductsbeneath the nipple.

• The nipple is preserved, but lactation is no longer possible.

• This a traditional open procedure that uses general anesthesia

Ductal Surgery for Cancer (Part of Lumpectomy or Mastectomy)

• This procedure is performed if DCIS or invasive ductal carcinoma (IDC) is present, ductal removal may be part of a lumpectomy or mastectomy.

• It involves removal of the duct along with surrounding breast tissue to prevent cancer spread.
• This a traditional open procedure that uses general anesthesia