Breast duct surgery for nipple discharge (Microdochectomy / total duct excision)

An operation to remove one milk duct (microdochectomy) or all the main ducts (total duct excision) to investigate and treat troublesome or suspicious nipple discharge.

✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review

In short

These operations remove one duct or all the main ducts to treat and investigate nipple discharge.
Most causes are benign, but surgery lets the tissue be checked to rule out anything serious.
Total duct excision usually means you cannot breastfeed from that breast afterwards, and nipple sensation may change.
It is done through a small cut at the edge of the nipple under general anaesthetic, usually as a day case.

A plain-English summary. The detail — including risks and recovery — is below.

At a glance

TypeSurgery (removal of breast duct(s))

AnaestheticGeneral anaesthetic

How long it takesUsually under an hour

Hospital stayDay case, usually no overnight stay

Time off workOften about a week

When you'll see resultsSymptoms usually addressed; tissue confirmed under the microscope within about 1–2 weeks

On the NHS?Commonly available on the NHS when discharge is troublesome or needs investigating

A general guide. Your surgeon will give you advice for your situation.

Best fit

Treats troublesome or persistent nipple discharge

Pause if

Normal physiological discharge from both breasts and several ducts, which often needs reassurance and investigation rather than surgery.

Main recovery point

Expect soreness, swelling and bruising around the nipple. Take simple painkillers, wear a supportive bra, and rest. After a general anaesthetic, do not...

Good aftercare

A clear results appointment explaining the cause of the discharge, with a timescale.

First 24–48 hours

Expect soreness, swelling and bruising around the nipple. Take simple painkillers, wear a supportive bra, and...

First week

Bruising fades and discomfort eases. Many people return to light activity and desk work within a week. Keep the...

Weeks 2–6

Swelling settles and dissolvable stitches disappear. The scar is pink and firm at first. Gradually return to...

About 1–2 weeks (results)

You are usually seen with the laboratory result, which explains the cause of the discharge and confirms whether...

Medical line illustration of breast imaging and biopsy sampling pathway for Breast duct surgery for nipple discharge. — Illustration only - not a diagnosis, medical advice or a promise of result. Your anatomy and treatment plan may differ. Vuemedics does not publish before-and-after photos.

What is microdochectomy or duct excision?

These operations treat and investigate troublesome nipple discharge by removing breast duct tissue from behind the nipple. Microdochectomy removes a single duct, usually the one producing the discharge. Total (or major) duct excision removes all the main ducts behind the nipple and is more commonly done, especially in older women or when several ducts are involved.

They are usually advised for discharge that is from a single duct, bloodstained or clear, persistent, or troublesome, and to find the cause. Most causes are benign, such as a small wart-like growth in a duct (a papilloma) or duct widening (duct ectasia), but surgery also allows the tissue to be examined to rule out anything more serious.

The operation is done through a small cut at the edge of the nipple (periareolar), usually under general anaesthetic as a day case. The removed tissue is sent to the laboratory.

An important point to understand beforehand is that removing the ducts usually means you will not be able to breastfeed from that breast afterwards, and nipple sensation may change. This matters especially if you may want to breastfeed in future.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Microdochectomy (single duct)

Removes the one duct producing the discharge, often after the duct is identified. May preserve the ability to breastfeed from the other ducts, and is favoured in younger women where possible.

Total (major) duct excision

Removes all the main ducts behind the nipple. More commonly done, especially in older women or when the discharge cannot be traced to a single duct. Usually prevents breastfeeding from that breast.

Duct excision for duct ectasia or infection

Used when widened or repeatedly infected ducts cause discharge, a lump behind the nipple, or recurrent infection.

Investigation before surgery

Imaging and sometimes a sample of the discharge or a biopsy are done first. Surgery is usually only after these, to confirm an operation is the right step.

Microdochectomy vs total duct excision

	Microdochectomy	Total duct excision
What is removed	One duct	All main ducts
Often used for	Single-duct discharge	Multiple ducts, older women
Breastfeeding after	May be possible	Usually not from that breast
Nipple sensation	May change	More likely to change

Your surgeon recommends one based on your age, the pattern of discharge and the imaging. Tell them if future breastfeeding matters to you.

Preparing for your surgery

See the operating surgeon and confirm what investigations (imaging, discharge sample) have already been done.
Ask whether one duct or all the ducts will be removed, and why.
Tell the surgeon if you may want to breastfeed in future, as this affects the choice of operation.
Follow fasting instructions for the general anaesthetic and arrange a lift home and someone to stay overnight.
Tell the team about all medicines and supplements, including blood thinners.
Stop smoking beforehand, as it slows healing and is linked to duct problems and wound complications.
Bring a comfortable, supportive bra to wear afterwards.

What happens

You are usually asleep under general anaesthetic. The surgeon makes a small cut at the edge of the nipple (periareolar), where it heals discreetly. For microdochectomy, the single offending duct is identified and removed. For total duct excision, all the main ducts behind the nipple are removed.

The wound is usually closed with dissolvable stitches under the skin. The operation generally takes under an hour and most people go home the same day.

The removed tissue is sent to the laboratory to find the cause of the discharge and to confirm it is benign. You are given advice on wound care, pain relief and when you will be seen with the result, usually in one to two weeks.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

May not be suitable if…

Normal physiological discharge from both breasts and several ducts, which often needs reassurance and investigation rather than surgery.
Discharge with a clear non-surgical cause (such as some medicines or a hormonal cause) that should be addressed first.
Wanting to keep the ability to breastfeed from that breast, where total duct excision would remove it — discuss alternatives.
An uncontrolled bleeding problem that has not been managed.

Delay surgery if…

There is active infection in the breast or overlying skin.
Investigations such as imaging or a discharge sample are incomplete.
You smoke and could stop first to improve wound healing.
Blood-thinning medicines have not been reviewed before surgery.

Alternatives to discuss

Investigation and monitoring without surgery for discharge that is not suspicious.
Treating an underlying cause, such as stopping a medicine or addressing a hormonal cause.
Microdochectomy rather than total duct excision where a single duct is responsible and breastfeeding matters.
Reassurance and breast awareness for normal physiological discharge.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

What matters most to me?

Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.

What are all my options?

Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.

What would make me pause?

Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.

What happens if I do nothing today?

For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

General anaesthetic

Standard for microdochectomy and total duct excision.

Benefits

Treats troublesome or persistent nipple discharge
Removes the cause, such as a duct papilloma or widened ducts
Allows the tissue to be examined to rule out anything serious
Can relieve recurrent infection from behind the nipple
The cut is placed where it usually heals discreetly
Gives a clear answer about the cause of the discharge

Risks & complications

More common

Bruising, swelling and tenderness for a few days
Changed or reduced nipple sensation, which can be lasting
A scar at the edge of the nipple
Loss of the ability to breastfeed from that breast, especially after total duct excision

Less common

The nipple turning inwards (inversion) or changing shape
Wound infection needing antibiotics
A collection of blood (haematoma) or fluid (seroma)
Discharge or symptoms continuing or coming back, sometimes needing further surgery

Rare but serious

Partial loss of the nipple or surrounding skin if blood supply is affected
A poor or thickened (keloid) scar in those prone to it
Finding an unexpected serious diagnosis needing further treatment
Persistent wound-healing problems, more likely in smokers

The key trade-offs are changed nipple sensation, possible nipple shape change, and usually losing the ability to breastfeed from that breast, particularly after total duct excision. Discharge can occasionally persist or return. Most causes are benign, but the operation is partly to make sure nothing serious is missed. Tell your surgeon if future breastfeeding matters to you, and ask how likely your symptoms are to be cured.

Published figures to discuss

Duct surgery is generally low-risk, but it commonly changes nipple sensation and the ability to breastfeed, and discharge can occasionally persist. Most underlying causes are benign, but a small proportion of patients having duct excision are found to have a more serious diagnosis on pathology. Reported figures vary between series, so this guide uses cautious wording rather than precise percentages.

Figure	Reported range	How to interpret it	Source / confidence
Loss of breastfeeding from the operated breast after total duct excision	Usual outcome when all main ducts are removed	Microdochectomy may preserve breastfeeding; discuss if this matters to you.	Guide sourcesClinical context
Serious diagnosis found on pathology after duct excision for discharge	A small minority in published series (low single-figure percentage)	Most causes are benign; examining the tissue is partly to be sure nothing serious is missed.	Guide sourcesClinical context
Nipple numbness, inversion or change in shape	Uncommon but recognised	Duct surgery is close to the nipple, so cosmetic and sensation changes should be discussed beforehand.	Guide sourcesClinical context
Discharge persisting or recurring	Uncommon to common depending on whether one duct or all ducts are removed	Persistent bloody or single-duct discharge after surgery needs reassessment.	Surgical outcomes of total duct excision — Annals RCS England (PMC)pmc.ncbi.nlm.nih.govSource-linked context

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

Recovery is usually straightforward, with most people sore for a few days and back to normal within about a week. The scar at the nipple edge fades over months.

First 24–48 hours

Expect soreness, swelling and bruising around the nipple. Take simple painkillers, wear a supportive bra, and rest. After a general anaesthetic, do not drive or make decisions for 24 hours.

First week

Bruising fades and discomfort eases. Many people return to light activity and desk work within a week. Keep the wound clean and dry as advised.

Weeks 2–6

Swelling settles and dissolvable stitches disappear. The scar is pink and firm at first. Gradually return to exercise as comfort allows.

About 1–2 weeks (results)

You are usually seen with the laboratory result, which explains the cause of the discharge and confirms whether anything further is needed.

What's normal — and not a worry

Bruising and tenderness around the nipple that improve over a week or two
Altered nipple sensation, which may be temporary or lasting
A pink, firm scar at the nipple edge that gradually pales
The nipple looking slightly different in shape while swelling settles

Aftercare

Take simple painkillers such as paracetamol as needed.
Wear a supportive, comfortable bra day and night at first.
Keep the wound clean and dry, following the advice you are given.
Avoid heavy lifting and vigorous exercise for the first week or two.
Avoid swimming until the wound has fully healed.
Protect the scar from sun while it settles.
Watch for signs of infection or a growing bruise and report them.
Attend follow-up so the result is explained and healing checked.

Before-surgery checklist

A supportive bra to wear day and night at first
Simple painkillers at home
Spare dressings if advised
Someone to drive you home and stay over after a general anaesthetic
Time off work arranged (often about a week)
The date and place for your results
The clinic's contact number for any concerns

Scars and how they heal

The cut is made at the edge of the nipple (periareolar), where the colour change in the skin helps hide the scar, so it usually fades to be discreet. It is pink and firm at first and pales over several months. The nipple can change shape or turn inwards, and sensation may be reduced or lost. Some people are prone to thickened or keloid scars; sun protection helps scars settle.

⚠ Get urgent help if…

Increasing redness, heat, swelling or discharge from the wound (possible infection)
A growing bruise or bleeding that will not stop
The nipple or surrounding skin turning dark or losing colour (possible blood-supply problem — seek help)
Fever or feeling generally unwell
Severe or worsening pain not eased by simple painkillers
The wound opening up
New or returning nipple discharge after healing — have it checked

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result is that the troublesome discharge stops, the wound heals, and the laboratory confirms a benign cause such as a papilloma or duct ectasia. For most people this resolves the problem and rules out anything serious.

Surgery cannot guarantee the discharge will never return, and it usually changes nipple sensation and the ability to breastfeed from that breast. If the tissue shows an unexpected or serious diagnosis, your team will explain whether further treatment is needed. Removing the ducts also does not prevent unrelated breast problems, so stay breast aware and attend routine screening.

How long it lasts

Removing the affected duct or ducts usually settles the discharge for good, particularly after total duct excision. Occasionally discharge or symptoms can persist or recur, sometimes needing further surgery. The changes to nipple sensation and breastfeeding are usually permanent. Any new nipple discharge or change in the future should be reassessed rather than assumed to be the same.

Combining with other procedures

Surgery normally follows investigation of the discharge, which may include a mammogram or ultrasound, examination of the discharge, and sometimes a duct study or biopsy. It is not usually combined with other operations. If imaging shows a separate lump, your surgeon will discuss whether that also needs sampling or removing.

Follow-up & long-term care

You will normally be seen with the laboratory result within a week or two, to explain the cause of the discharge, confirm it is benign, and check the wound is healing. Most people need no long-term follow-up afterwards. If the result is unexpected, or symptoms continue, you will be given a clear plan for further investigation or treatment.

Revision and secondary surgery reality

Discharge can occasionally persist or recur after surgery and may need a further operation.
Microdochectomy may be followed by total duct excision if symptoms continue.
An unexpected serious result on pathology may lead to further treatment.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

A clear results appointment explaining the cause of the discharge, with a timescale.
Wound-care advice and a named contact for any concerns.
An honest discussion of nipple sensation, shape and breastfeeding before and after surgery.
A defined plan if discharge persists or the pathology is unexpected.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

Whether one duct (microdochectomy) or all ducts (total duct excision) are removed
The surgeon's fee, anaesthetist's fee and theatre or facility fee
Any imaging or duct study needed before surgery
Laboratory (pathology) fees for examining the tissue
Follow-up appointments and wound checks
Any further surgery if symptoms persist or the diagnosis changes

Make sure your written quote includes

The surgeon's fee and the anaesthetist's fee
Theatre or facility fee
Pre-operative imaging and pathology (laboratory) fees
A results consultation and any wound checks
What happens, and what it costs, if discharge persists or further surgery is needed
Cancellation policy and what happens if a complication occurs

On the NHS? Investigation and surgery for troublesome or suspicious nipple discharge are commonly available on the NHS when clinically indicated; private clinics may be used for speed, choice or self-pay.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Choosing a surgeon safely

Check your surgeon is on the GMC Specialist Register for this area.
Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

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Questions to ask your medical professional

Take this to your consultation. A good surgeon will welcome every one of these.

Will you remove one duct or all of them, and why?
How will this affect my nipple sensation and the look of my nipple?
Will I still be able to breastfeed from this breast afterwards?
How likely is this to stop my discharge for good?
What investigations have confirmed surgery is the right step?
What happens if the tissue shows something unexpected?
Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
Will you be the surgeon who carries out my operation, and who looks after me afterwards?
What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
What does a realistic result look like — and what can this operation not achieve?
What are my options, including waiting, doing nothing for now, or choosing a different approach?
Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Frequently asked questions

Is duct surgery available on the NHS?

Yes. Troublesome or suspicious nipple discharge is commonly investigated and treated on the NHS, including with duct surgery when needed. Some people use private clinics for speed or choice.

Will I still be able to breastfeed afterwards?

After total duct excision you usually cannot breastfeed from that breast. Microdochectomy, which removes a single duct, may preserve breastfeeding. Tell your surgeon if future breastfeeding matters to you.

Will my nipple look or feel different?

Nipple sensation is often reduced or changed, and the nipple can change shape or turn inwards, especially after total duct excision. The scar is placed at the nipple edge to fade discreetly.

Does nipple discharge mean I have cancer?

Most nipple discharge has a benign cause, such as a papilloma or widened ducts. Surgery treats the discharge and lets the tissue be checked so that anything serious is not missed.

Will the discharge definitely stop?

Usually yes, especially after total duct excision. Occasionally discharge can persist or come back and may need further treatment. Your surgeon can give you a realistic expectation.

How long is the recovery?

Most people are sore for a few days and back to normal within about a week, with the scar fading over months. Heavy lifting and vigorous exercise are best avoided for the first week or two.

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Nipple discharge Association of Breast Surgery — information hub Surgical outcomes of total duct excision — Annals RCS England (PMC) Role of duct excision for pathological nipple discharge — systematic review (PMC)

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.