Mammary Duct Ectasia

Question 1

What is it?

Answer 1

Mammary duct ectasia is a benign condition where there is dilation of the large ducts in the breasts. Ectasia means dilation. There is inflammation in the ducts, leading to intermittent discharge from the nipple. The discharge may be white, grey or green.

Mammary duct ectasia occurs most frequently in perimenopausal women. Smoking is a significant risk factor.

Question 2

Presentation?

Answer 2

Mammary duct ectasia may present with:

Nipple discharge
Tenderness or pain
Nipple retraction or inversion
A breast lump (pressure on the lump may produce nipple discharge)

Question 3

Diagnosis?

Answer 3

The initial priority is to exclude breast cancer, as they can present in similar ways. This involves triple assessment with:

Clinical assessment (history and examination)
Imaging (ultrasound, mammography and MRI)
Histology (fine needle aspiration or core biopsy)

Microcalcifications are a key finding to remember on a mammogram, although they are not specific to mammary duct ectasia.

Other investigations that may be performed:

Ductography – contrast is injected into an abnormal duct, and mammograms are performed to visualise the duct
Nipple discharge cytology – examining the cells in a sample of the nipple discharge
Ductoscopy – inserting a tiny endoscope (camera) into the duct

Question 4

Management?

Answer 4

Reassurance after excluding cancer may be all that is required
Symptomatic management of mastalgia (supportive bra and warm compresses)
Antibiotics if infection is suspected or present
Surgical excision of the affected duct (microdochectomy) may be required in problematic cases