Central mammary duct excision – a randomised controlled study between two different surgical techniques

Abstract

Background: Since the 1960s, mammary duct ectasia (MDE) has been surgically treated by the Hadfield technique. After 1999, the Al-Masad technique was developed to overcome the adverse events related to the former technique. However, literature comparing both techniques is still deficient. The purpose of this study was to compare both techniques in terms of nipple sensation, recurrence of symptoms, nipple-areola complex (NAC) necrosis, nipple retraction and any other complications.

Methods: This prospective randomised clinical trial was performed at the Alexandria Main University Hospital, Egypt, and included consecutive patients with mammary duct ectasia who were randomly assigned into two groups – group A who were treated using the Al-Masad technique, and group B who were treated using the Hadfield technique.

Results: The study included 130 patients (group A = 65 patients and group B = 65 patients) with a mean age of 51.42 ± 5.1 years (p = 0.564). Most lesions were unilateral in both groups (76.9% vs 83.1%; p = 0.38). The main indication for surgery was significant copious discharge in both groups (61.5% vs 52.3%; p = 0.56). Intraoperative details were comparable between both groups. The main pathological finding was duct ectasia with and without periductal mastitis (46.2% vs 52.3%; p = 0.78). Both groups had a comparable incidence of postoperative complications, except nipple retraction, which had a higher frequency among group B (2.5% vs 15.8%; p = 0.004).

Conclusion: The Al-Masad technique was as effective as the Hadfield technique in treating mammary duct ectasia with lower postoperative complications, especially nipple retraction.