Hadfields operation is performed for which of the following pathology?
Correct Answer: Duct ectasia
Description: Ans. is 'a' i.e., Duct ectasia Duct ectasia/periductal mastitis* This is a dilatation of the breast ducts, which is often associated with periductal inflammation.* The classical description of the pathogenesis of duct ectasia asserts that the first stage in the disorder is a dilatation in one or more of the larger lactiferous ducts, which fill with a stagnant brown or green secretion. This may discharge.* These fluids then set up an irritant reaction in surrounding tissue leading to periductal mastitis or even abscess and fistula formation.* In some cases, a chronic indurated mass forms beneath the areola, which mimics a carcinoma. Fibrosis eventually develops, which may cause slit-like nipple retraction.* A marked association between recurrent periductal inflammation and smoking has been demonstrated. It is certainly clear that cessation of smoking increases the chance of a long-term cure.Clinical features* Nipple discharge (of any colour), a subareolar mass, abscess, mammary duct fistula and/or nipple retraction are the most common symptom/s.Treatment* In the case of a mass or nipple retraction, a carcinoma must be excluded by obtaining a mammogram and negative cytology or histology. If any suspicion remains the mass should be excised.* Antibiotic therapy may be tried, the most appropriate agents being co-amoxiclav or flucloxacillin and metronidazole.* However, surgery is often the only option likely to bring about cure of this notoriously difficult condition; this consists of excision of all of the major ducts (Hadfield's operation). It is particularly important to shave the back of the nipple to ensure that all terminal ducts are removed. Failure to do so will lead to recurrence.
Category:
Surgery
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