FFinalistSouthampton · 2027
Endocrine
AKT · Endocrine/Breastlow yield

Duct ectasia

Dilatation/inflammation of subareolar ducts (perimenopausal; smokers)

Overview

Dilatation and inflammation of the subareolar ducts, common around the menopause and in smokers. Causes a thick, often green/creamy or blood-stained nipple discharge, nipple retraction and a periareolar lump/inflammation. Benign, but discharge and retraction overlap with cancer — so triple assessment is needed.

Recognise

  • Thick, cheesy/green/creamy (sometimes blood-stained) nipple discharge, often from multiple ducts and both sides
  • Slit-like nipple RETRACTION; periareolar lump or inflammation (periductal mastitis); perimenopausal, smoking-associated
  • Benign but mimics cancer (discharge + retraction)

Red flags

  • Blood-stained SINGLE-duct discharge → exclude intraductal papilloma/carcinoma (refer)
  • Nipple retraction with a mass → triple assessment to exclude cancer

Differentials & how to tell them apart

Intraductal papillomasingle-duct BLOODY discharge from a small lesion — needs excision
Breast cancersingle-duct bloody discharge, hard mass, skin change
Periductal mastitisacute periareolar inflammation/abscess (often the same smoking-related spectrum)

Investigations

Triple assessment (mammography/ultrasound ± ductography); exclude malignancy. Smoking history.

Management

Reassurance + triple assessment (duct excision if troublesome)

  1. 1Triple assessment to exclude malignancy. Reassure; advise smoking cessation (periductal disease).Gate: A SINGLE-duct BLOODY discharge is not typical duct ectasia — exclude an intraductal papilloma or carcinoma
  2. 2Total duct excision for persistent troublesome discharge or recurrent periductal mastitis.
Reassurance ± smoking cessation — benign; most need no treatment
Surgery (duct excision) — for troublesome discharge or recurrent infection

Key points

Thick multi-duct green/creamy discharge + slit-like retraction in a perimenopausal smoker = duct ectasia (benign). Single-duct bloody discharge points to papilloma/cancer instead.

Monitor & prognosis

After excluding malignancy; recurrence.

Benign.

Source: NICE NG101; CKS Breast