Microductectomy under local anaesthetic for pathological nipple discharge. Is it time to change practice?

Pathological nipple discharge (PND) is a common clinical concern that requires careful evaluation to rule out malignancy. Microductectomy is the gold-standard surgical intervention for both diagnosis and symptom relief. In most centres, it is usually performed under general anaesthesia. This study aims to assess the feasibility, efficacy, and safety of performing microductectomy under local anaesthesia without sedation, a technique adapted during the COVID-19 pandemic to address resource constraints.

A retrospective review was conducted on all patients who underwent microductectomy under local anaesthesia at Groote Schuur Hospital between January 2021 and December 2022. Data were collected on demographics, imaging used, imaging findings, biopsy results, and histological diagnoses.

A total of 23 patients were included, with a median age of 55 years (interquartile range, IQR, 45-60 years). All patients presented with spontaneous nipple discharge (ND), with 75% reporting bloody ND. Dual imaging (mammography and ultrasound) was performed in 78.2% of cases, while 39.1% of patients underwent preoperative biopsy. Histology revealed intraductal papilloma in 65.2%, ductal hyperplasia in 39.1%, and ductal ectasia in 21.7% of cases. One patient (4.3%) was diagnosed with papillary ductal carcinoma in situ (DCIS). No invasive malignancy was detected, and no complications were reported postoperatively.

Microductectomy conducted under local anaesthesia without sedation appears to be a safe, effective, and feasible method for managing PND. It benefits resource-limited settings by decreasing reliance on general anaesthesia while preserving diagnostic and therapeutic efficacy. Further prospective studies with larger sample sizes incorporating patient satisfaction, procedure duration, diagnostic yield, recurrence rates, and completeness of excision are advised to evaluate long-term outcomes and patient experiences.