Definition & Overview
Nipple exploration is a medical procedure used to diagnose the cause of nipple discharge, a common symptom of both benign and malignant breast lesions. If the patient is found to have a solitary or papilloma lactiferous duct, it can be excised during the same procedure.
Who Should Undergo and Expected Results
A nipple exploration procedure can be recommended for patients who suffer from nipple discharge, which is one of the most common breast-related symptoms among women. Although it can occur even in benign cases, nipple discharge can also be an early cancer symptom.
Nipple discharge is evaluated based on:
- Frequency/spontaneity – The discharge that comes out spontaneously (even when the breast is not squeezed) is a cause for concern. In contrast, if the discharge only comes out by squeezing, patients are advised to keep from squeezing their breasts. But they need to watch out for signs of spontaneous discharge, such as wetness in their bra or top during the night.
- Colour – Clear or bloody discharges should be brought to the attention of a doctor. On the other hand, green or milky discharges are often not worrisome.
- Single/multiple ducts – If the discharge comes from multiple spots on the nipple, it is likely to be nothing serious. However, if the discharge only comes from one spot, the patient should consult a physician.
These discharges can be caused by:
- Benign ductal conditions
- Intraductal papilloma, or non-cancerous growths inside the breast ducts, including the lactiferous duct
- Ductal estasia, or the dilatation of major ducts
- Fibrocystic breast changes
- Plasma cell mastitis
- Malignant ductal conditions, or a cancerous growth within the ducts
- Endocrinologic conditions, or conditions that increase prolactin production
It is important to note that physicians usually use other less invasive methods to diagnose nipple discharge before resorting to nipple exploration. They usually start with a physical examination followed by a ductogram. A ductogram is a procedure in which a contrast dye material is placed into the duct. The contrast dye material shows up vividly on an x-ray scan, making it easy for the physician to see any abnormalities in the duct.
But if the ductogram shows normal results (the doctor did not find anything suspicious in the ducts), and the discharge continues, a surgical nipple exploration becomes the only remaining option.
Up to 90% of all nipple exploration biopsies are related to benign abnormalities in the ducts. If a benign abnormality is found, the doctor can remove it during the same procedure. In most cases, the discharge stops after the excision, and patients only need to see the doctor again for a follow-up check.
Benign abnormalities in the mammary ducts are called papillomas, which can cause complete duct obstruction if not treated. Papillomas are made up of mammary epithelium, the same cells that make up the lining of the ductal walls. Papillomas are highly common among women between the ages of 35 and 55. There are two types of papillomas:
- Solitary papilloma – A single benign growth affecting just one lactiferous duct. It is very prone to nipple discharge.
- Multiple papillomas – These are growths that occur in groups. Also called papillomatosis, the condition is harder to manage.
Both of these types of growths may be excised during a nipple exploration procedure.
If a cancerous duct is found, the doctor will determine if it is possible to remove the entire papilloma in the same procedure. After the excision, the doctor and patient will discuss other necessary cancer treatments. Most cancers detected through a nipple exploration due to a discharge are early stage cancers. Thus, patient prognosis is generally good.
If no abnormal ducts are found or if it is impossible to remove a cancerous duct during the same procedure, the exploration will not involve an excision. The doctor and patient can then discuss the next steps moving forward.
How is the Procedure Performed?
The following steps are taken during a nipple exploration:
- The patient is first placed under general anaesthesia.
- The surgeon makes an incision through the breast skin. This is usually made near the edge of the areola so that any resulting scar tissue will not be noticeable.
- Once the breast tissue is exposed, the surgeon will explore it until the ducts are reached.
- The surgeon then checks the lactiferous duct for signs of an abnormal growth.
- If a solitary or a papilloma lactiferous duct is found, the surgeon will proceed with the ductal excision.
- The incision is then closed with sutures.
Patients are given antibiotics and pain medications upon being discharged from the hospital. The breasts are typically covered with a bandage for protection. Patients are also advised to wear a sports bra.
Possible Risks and Complications
Patients who undergo a nipple exploration are at risk of:
- Allergic reaction to anaesthesia
- Temporary or permanent loss or reduction of nipple sensation
- Heightened nipple sensitivity
Patients who had a solitary papilloma removed do not require an extensive follow-up plan and are generally not at risk of developing breast cancer. In contrast, patients who had multiple papillomas excised need to undergo annual checkups due to the high risk of cancer.
Sarakbi WA, Worku D, Escobar PF, Mokbel K. “Breast papillomas: Current management with a focus on a new diagnostic and therapeutic modality.” Int Semin Surg Oncol. 2006; 3:1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1395317/
Snyder WH, Chaffin L. “Main duct papilloma of the breast.” JAMA Arch Surg. 1955;70_95):680-685. http://archsurg.jamanetwork.com/article.aspx?articleid=552407