Name of the Procedure:

Excision of Lactiferous Duct Fistula
Common name: Breast duct excision, Fistula removal surgery

Summary

The excision of a lactiferous duct fistula involves surgically removing a fistula that has formed between a milk duct in the breast and the skin. This procedure aims to alleviate symptoms and prevent recurrent infections or discharge.

Purpose

This procedure addresses a lactiferous duct fistula, an abnormal connection that forms due to inflammation, infection, or trauma. The goal is to eliminate the fistula to prevent recurrent infections, manage discharge, and alleviate discomfort.

Indications

• Persistent discharge from the nipple
• Recurrent infections in the affected duct
• Discomfort or pain associated with the fistula
• Failure of conservative treatments to resolve the fistula
• Physical symptoms negatively impacting quality of life

Preparation

• Fasting for at least 6-8 hours before the surgery if general anesthesia is used.
• Discontinuation of certain medications, such as blood thinners, as instructed by the physician.
• Preoperative diagnostic tests, including mammograms or ultrasound scans to locate the fistula accurately.
• Physical examination and review of medical history by the surgeon.

Procedure Description

1. Anesthesia: Administering general or local anesthesia to ensure patient comfort.
2. Incision: Making a small incision over the site of the fistula.
3. Excision: Carefully excising the affected duct and surrounding tissue to remove the fistula completely.

4. Closure: Closing the incision with sutures and applying a sterile dressing.

   Standard surgical instruments such as scalpels, forceps, and sutures are used.

Duration

The procedure typically takes between 1 to 2 hours, depending on the complexity and extent of the fistula.

Setting

This procedure is usually performed in an outpatient clinic or hospital surgical center.

Personnel

• Surgeon: Performs the excision.
• Nurse: Assists with the procedure and patient care.
• Anesthesiologist: Administers anesthesia and monitors the patient.

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Scarring or changes in breast appearance
• Adverse reactions to anesthesia
• Recurrence of the fistula
• Damage to surrounding breast tissue

Benefits

• Relief from recurrent infections and persistent discharge.
• Improved quality of life with reduced discomfort.
• Fast recovery with minimal complications.

Recovery

• Apply ice packs to reduce swelling and discomfort.
• Take prescribed pain medication as needed.
• Keep the incision site clean and dry, following specific wound care instructions.
• Avoid heavy lifting and strenuous activities for a few weeks.
• Follow-up appointments to monitor healing and assess for any complications.

Alternatives

• Antibiotics: May be tried to manage infection but are not a permanent solution for a fistula.
• Observation: Monitoring the fistula for changes without immediate surgery, suitable for less severe cases.
• Minimally invasive procedures: Such as ductal lavage or catheter-based interventions, but these may not be as effective for larger or persistent fistulas.

Patient Experience

During the procedure, patients under general anesthesia will be asleep and feel no pain. With local anesthesia, they may feel pressure but should not experience pain. Post-procedure, there may be some discomfort and swelling, which can be managed with pain medication and proper care. Most patients can resume normal activities within a few weeks, feeling significant relief from previous symptoms.