Transaxillary three-dimensional endoscopic segmental ductal resection for pathological nipple discharge: a case...

Pathological nipple discharge often requires surgery to remove the affected duct. The conventional circumareolar incisions are generally satisfactory but may result in local hypoesthesia or in ischemic necrosis of the nipple-areola complex because of neurovascular disruption. Therefore, alternative, minimally invasive techniques to reduce this structural damage are being investigated.

A 30-year-old woman presented with a history of serous unilateral nipple discharge for six months. Mammary ductoscopy indicated an intraductal space-occupying lesion, and this was then marked with precise intraductal staining with methylene blue. A three-dimensional endoscopic-assisted segmental ductal resection was performed through a small incision in the natural axillary fold, utilizing the posterior chest space. This particular technique aimed to prevent direct surgical trauma to the central areolar region. Histopathology and immunohistochemistry after surgery indicated the possibility of a benign intraductal papilloma. Patient's recovery was uneventful without complications. The clinical assessment indicated good maintenance of the papillary-areolar blood supply, no serious hypoesthesia of the skin, and no visible scarring of the breast surface.

The three-dimensional endoscopic-assisted axillary approach may be a useful and aesthetically favorable alternative for managing benign intraductal lesions. It may decrease local postoperative complications of traditional incisions, but more clinical studies are required to determine its wider application.