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Duct Ectasia of the Breast

Duct ectasia of the breast is a benign condition caused by the distention and clogging of milk channels or ducts in the breast. It is more commonly seen in smokers. It is not precancerous.

female breast examination

So you have just seen your doctor to review the results after having a breast ultrasound scan and have you been told that you have breast or mammary duct ectasia?

Or was it that you came in to see your doctor because of pain and swelling in one of your breasts, with or without an associated brown or greenish discharge from your nipple and after a scan you were told you have duct ectasia?

Are you somewhat worried and wondering what exactly is duct ectasia of the breast? Could this be breast cancer? Am I in trouble?

No. You are not in trouble.

What Is Duct Ectasia of the Mammary Gland?

Duct ectasia of the breast or mammary gland is an absolutely benign breast condition occurring due to distension of the milk draining ducts beneath the nipple and clogging of these ducts.

It is also called:

  • Periductal mastitis
  • Ductal ectasia
  • Comedo mastitis or
  • Plasma cell mastitis.

This is because, there is often an associated on going surrounding chronic inflammation around the blocked duct.

This inflammatory changes lead to scar formation and retraction of the nipple.

Duct ectasia could affect only one or both breasts simultaneously.

It is commonly seen in women in their early 40s to 55 years of age, though it can occur later in life.

Ductal ectasia is also more commonly seen in women who smoke, or who are exposed to cigarette smoke over a long period of time.

Though the exact cause of ductal ectasia is unknown, it is believed to result from from a chronic irritation and inflammation around the affected ducts, leading to clogging of the ducts with secretions, dead tissues and pus.

In some cases, these blocked ducts could lead to abscess formation.

Symptoms of Ductal Ectasia

Most women with this condition would have no obvious symptoms, especially in the early stage.

The most common symptoms of duct ectasia of the breast are:

  • A thick greenish, dark or brownish discharge from the nipple
  • Swelling and redness around the nipple
  • Distorted nipple shape
  • Pain around the nipple
  • Painless breast lump very close to the nipple
  • Ulcer around the nipple

One or both breast could be affected at the same time.

Diagnosis

Diagnosis is usually done with the aid of a breast ultrasound scan.

Your doctor will likely examine your breast carefully if you came with any of the above symptoms to establish that there is a change in your breast structure. The usual finding is that of a tube-like swelling under the nipple.

He or she would then send you for a breast ultrasound and depending on how your breast feels and your age, a mammogram.

Ultrasound scan is more informative than a mammogram in the diagnosis of ductal ectasia.

When the diagnosis is still in doubt, some doctors may proceed with a fine-needle aspiration biopsy to see if it is something more serious. But this would not be necessary if the reporting radiologist is sure that the ultrasound findings is consistent with a periductal mastitis.

Treatment

  • No treatment is usually required for simple ductal ectasia - if no abscess or pain or redness or significant nipple retraction.
  • If there is pain and or redness around the nipple, it may be necessary to treat ductal ectasia with antibiotics. The most common types of bacteria found in secretions of ductal ectasia are a group of bacteria referred to as anaerobes. For this reason, a combination of flucloxacillin (or cloxacillin) and metronidazole is often used.
  • Warm compress. This involves the use of a face cloth or bath towel dipped into a bowl of warm water, squeezed dry and then used to apply pressure to the affected breast, for 10 to 15 minutes, up to three times a day.
  • If the nipples are retracted (that is, drawn in-wards), surgery may be required. This is a special type of breast surgery called the Hadfield's operation, where all the distended large milk ducts are excised.

Ductal Ectasia And Breast Cancer

To be clear, there is no relationship between ductal ectasia and breast cancer.

Breast cancer is due to changes in the cells of breast, while ductal ectasia is due to a mechanical blockage and chronic inflammation and in some cases, infection of the breast.

Ductal ectasia is not a risk factor for breast cancer.

References:

  • Bailey's & Love's Short Practice of Surgery. 23rd Edition. Edited by RCG Russell, Norman S. Williams & Christopher J.K Bulstrode. Page 757. Co-published in the USA by Oxford University Press Inc., New York.
  • Rahal RM, de Freitas-Junior R, Paulinelli RR. (2005) Risk factors for duct ectasia. Breast J. 2005 Jul-Aug;11(4):262-5. https://www.ncbi.nlm.nih.gov/pubmed/15982393
  • Guangzhou hu xi ji bing yan jiu suo Hu xi ji bing guo jia zhong dian shi yan shi. Clinical characteristics, classification and surgical treatment of periductal mastitis. J Thorac Dis. 2018 Apr;10(4):2420-2427. doi: 10.21037/jtd.2018.04.22. https://www.ncbi.nlm.nih.gov/pubmed/29850148

Last Updated: 9th Day of September 2018.

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