Management of mammillary fistulae

Mammillary fistulae develop between the lactiferous ducts of the breast and areolar skin. Over a 14-year period 41 fistulae were treated in 36 patients (34 women, 2 men). In 24 women at least one subareolar abscess (mean 2.5) had been incised and drained previously. Fourteen fistulae developed after discharge of an inflammatory mass and three after surgical biopsy. Twelve women underwent 13 fistulectomies, two of which required reoperation. The remaining 24 patients with complicated fistulae (n = 28) had previously undergone multiple surgical procedures; 12 patients had 13 fistulae treated by total duct excision and primary closure without antibiotic cover and six fistulae required reoperation. Fifteen fistulae in 12 women were treated by duct excision with either primary closure under antibiotic cover (n = 7) or packing with healing by granulation (n = 8) and only one recurred (P less than 0.05). Operations for mammillary fistulae should be treated as contaminated procedures. In simple cases where no previous surgery has taken place, fistulectomy is appropriate. In complicated cases, treatment should be duct excision with the wound either closed primarily under antibiotic cover or left open to heal by secondary intention.