Definition & Overview
Lactiferous or milk ducts carry milk to the surface of the skin and out of the tiny pores in the nipples. When these are blocked, their content spills into the surrounding tissue leading to inflammation. If left untreated, abscesses and a fistulous tract can form in the area. A fistula is an abnormal hole where the abscess drains.
A lactiferous duct fistula is also known as Zuska’s breast disease. It is a rare but painful breast disorder. It is not associated with breast cancer, lactation, or pregnancy. Its symptoms include prolonged breast pain, abnormal discharge, and swelling. Doctors treat acute cases using antibiotics and incisional-drainage procedures. However, the definitive therapy for the disorder is the surgical removal of the fistula including all affected tissue. This effectively addresses all associated symptoms and guarantees against recurrences.
Who Should Undergo and Expected Results
The excision of a lactiferous duct fistula is carried out for patients diagnosed with Zuska’s breast disease. Because the disease shares many symptoms with breast cancer, the main problem commonly encountered by patients is having their condition misdiagnosed.
Patients suffering from Zuska’s breast disease typically have the following symptoms:
- Abnormal discharge from the fistula
- Severe and prolonged breast pain
- Nipple retraction
- Breast inflammation
- Recurring infection
- Breast lump
Lactiferous duct fistulas commonly occur in younger and middle-aged women who are not pregnant or lactating. Various studies confirm that among the risk factors are diabetes, smoking, and nipple piercing. However, its definite cause is yet to be established.
How is the Procedure Performed?
When patients with Zuska’s breast disease consult their doctors, the first thing that doctors do is to make sure that it is not breast cancer. They perform a breast exam to assess the lump and the abnormal hole (fistula). If they cannot make a definitive diagnosis based on the physical exam, the following are performed:
Ultrasound – This helps doctors in thoroughly assessing an abscess deep in the breast. It is safe and noninvasive. It is done by simply placing an ultrasound probe over the affected breast.
A sample of pus draining from the fistula is collected and sent to a lab. This helps determine the kind of infection that the patient has and the type of antibiotic to prescribe.
Blood test and magnetic resonance imaging (MRI) - If the doctor requires more information to confirm a diagnosis, blood tests and MRI may be performed. This allows doctors to thoroughly assess the structures under the skin. This also helps rule other types of diseases.
After making a definite diagnosis, the doctor will prescribe the most appropriate treatment. Mild cases are treated with antibiotics and pain relievers. The abscess is also drained using a needle and syringe (aspiration). It can also be drained using a small incision. These options are applicable if the abscess is located near the surface of the skin. The procedures can be done in an emergency room or doctor’s office. They are effective in relieving symptoms but does not guarantee against recurrence. In some cases, the procedure is repeated multiple times if the condition recurs. However, this can result in nipple and breast distortion as well as scarring.
The excision of lactiferous duct fistulas is considered the definitive therapy for the condition. It addresses not just the symptoms but also the cause of the problem. It is typically considered when the infection does not go away following antibiotic therapy and multiple incisional-drainage procedures. The surgery involves making an incision on the breast to remove the fistula and all affected glands. It is performed under general anaesthesia and in an operating room. In severe cases, mastectomy is considered. Reconstructive procedures to restore the breast’s shape and contour can also be performed following surgery.
Based on various studies, almost 50% of patients with a lactiferous duct fistula are completely treated with incision and drainage with antibiotics. However, the rest needed definitive duct excision to fully treat the problem.
Possible Risks and Complications
The excision of a lactiferous duct fistula can be an outpatient or inpatient procedure depending on the severity of the case. Although considered safe, it comes with a number of possible risks and complications, including:
- Allergic reaction to anaesthesia used
- Damage to surrounding tissues
- Temporary swelling of the breast
- Breast pain
Patients must call their doctor if they experience vomiting, high fever, and increasing pain and swelling in the surgical site. Patients must also see their doctor after one to two weeks for a follow-up. During the follow-up, the doctor will make an assessment to make sure that the infection has completely cleared.
Versluijs, F. N. L.; Roumen, R. M. H.; Goris, R. J. A. (2000). "Chronic recurrent subareolar breast abscess: incidence and treatment". British Journal of Surgery.
An HY, Kim KS, Yu IK, Kim KW, Kim HH (June 2010). "Image presentation. The nipple-areolar complex: a pictorial review of common and uncommon conditions". Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine (review). 29 (6): 949–62.