Microdochectomy in India and UAE | Complete Patient Guide

• Women presenting with spontaneous, unilateral, uniductal nipple discharge that is blood-stained (haemorrhagic), serous, or serosanguineous on at least two clinical assessments

• Patients with a cytology-positive nipple discharge smear indicating epithelial atypia or suspicious cells

• Women in whom ductoscopy or galactography has identified an intraductal filling defect consistent with a papilloma or polypoid lesion

• Patients with a palpable subareolar mass associated with discharge where fine-needle aspiration cytology (FNAC) or core needle biopsy is inconclusive

• Women with a confirmed diagnosis of intraductal papilloma on core biopsy who require therapeutic excision to exclude upgraded pathology (ADH/DCIS)

• Required pre-operative diagnostics: bilateral mammography (digital full-field or tomosynthesis), targeted breast ultrasound with Doppler assessment, breast MRI (recommended if lesion is not sonographically visible), nipple discharge cytology, ductoscopy or galactography for duct mapping, and routine haematology/coagulation panel

• Contraindications: Active, uncontrolled periductal infection requiring antibiotic resolution before surgery; bleeding diathesis uncontrolled by perioperative management; pregnancy (relative contraindication — surgery deferred to second trimester if oncologically safe); bilateral multi-ductal discharge more consistent with physiological galactorrhoea, in which case prolactin and thyroid function testing must exclude endocrine aetiology before surgical referral

Standard Open Microdochectomy (Selective Duct Excision): The conventional and most widely performed technique. Under general anaesthesia or local anaesthesia with IV sedation, a circumareolar or periareolar incision is fashioned. A fine lacrimal probe (sizes 00–0) is passed into the discharging duct orifice; methylene blue dye is injected to stain the duct lumen. A cone of breast tissue 4–6 cm deep, encompassing the stained duct, is excised en bloc. Haemostasis is achieved with bipolar diathermy, and the wound is closed in layers with absorbable sutures and a subcuticular skin closure to minimise scarring. Operative time is typically 30–60 minutes.

Ductoscopy-Guided Microdochectomy (Advanced Approach): A 0.9–1.2 mm fibreoptic microendoscope (Karl Storz or Polydiagnost ductoscope) is passed through the duct orifice under direct vision before or during the surgical procedure. Intraductal papillomas are directly visualised; the endoscope's position at the lesion guides precise duct excision, reducing the volume of breast tissue removed by up to 40% compared to blind excision. Some centres perform intraductal biopsy or basket polypectomy through the ductoscope, offering a minimally invasive biopsy-first strategy.

Wire-Guided or Radio-Guided Localisation: For non-palpable lesions identified only on MRI or galactography, hookwire localisation or radioguided occult lesion localisation (ROLL) using technetium-99m nanocolloid is performed by the radiologist immediately before surgery. The surgeon then excises the wire-bracketed or radiolabelled tissue with intraoperative gamma-probe confirmation, ensuring complete lesion removal with a minimum 1 mm clear margin.

Total Duct Excision (Hadfield's Procedure — Comparative Reference): When discharge is multi-ductal, bilateral, or associated with diffuse ductal ectasia, total duct excision (excision of all major subareolar ducts en bloc) is preferred over selective microdochectomy. This broader procedure carries a higher risk of nipple retraction and loss of nipple sensation and is not the standard for uniductal disease.

Intraoperative Frozen Section: Leading centres affiliated with GAF Healthcare offer intraoperative frozen section histology of the duct specimen margin, enabling the surgeon to extend excision to clear margins within the same anaesthetic episode if DCIS is found, avoiding a second operation.

Step 1 — Remote Consultation & Workup (2–4 weeks before travel): The patient shares existing imaging (mammogram, ultrasound, MRI DICOM files) and cytology reports with the GAF Healthcare-assigned breast surgeon via a secure teleconsultation. Any outstanding investigations — particularly breast MRI or galactography — are arranged locally or on arrival. The anaesthesiology team reviews the patient's ASA physical status classification and co-morbidities.

Step 2 — Arrival & Pre-operative Assessment (Day 1–2): The patient arrives in India or the UAE. GAF Healthcare's ground team arranges airport pickup and hospital admission or hotel accommodation. Pre-operative blood work (full blood count, coagulation screen, renal and liver function, group and save), an ECG, and a brief anaesthetic assessment are completed. The breast surgeon performs a clinical examination and confirms the operative plan. Pre-operative ductoscopy or wire localisation is scheduled with the radiology team if required.

Step 3 — Surgery Day (Day 2–3): The patient is admitted to the day-surgery or short-stay unit. General anaesthesia or local anaesthesia with monitored sedation is induced. Total operative time is 30–90 minutes depending on localisation technique. The patient is transferred to the recovery unit and typically mobilised within 2–4 hours of completing anaesthesia. The excised specimen is sent immediately to pathology; preliminary intraoperative frozen section results (if requested) are available within 30–40 minutes.

Step 4 — Early Post-operative Period (Day 2–4, Hospital/Hotel): Wound is assessed at 24–48 hours; a small drain (if placed) is removed on Day 1. Pain management is achieved with paracetamol and NSAIDs; opiates are rarely required beyond the first 24 hours. The patient is discharged to hotel or serviced apartment accommodation with wound-care instructions, a surgical bra, and contact details for the nursing team.

Step 5 — Histopathology Review (Day 5–10): Final paraffin-section histopathology — including immunohistochemistry for ER, PR, and HER2 if atypia is present — is available within 5–7 working days. The breast surgeon reviews results in a face-to-face or video consultation. If pathology is benign (papilloma without atypia), no further surgery is required. If DCIS or invasive carcinoma is identified, the oncology multidisciplinary team convenes to recommend the next step (wider excision, sentinel node biopsy, or mastectomy), which the patient may elect to undergo locally or at home.

Step 6 — Fit-to-Fly Clearance (Day 10–14): Sutures are removed (or confirmed dissolved). The wound is inspected for signs of infection or haematoma. The surgeon provides a fit-to-fly letter, a complete medical summary, and digital copies of all pathology and imaging reports. Patients are advised to wear compression garments and keep the wound dressed during the flight. DVT prophylaxis (low-molecular-weight heparin) is prescribed for long-haul flights exceeding 6 hours where clinically indicated.

Step 7 — Remote Follow-up at Home (Weeks 3–6): GAF Healthcare facilitates a virtual follow-up consultation at 4 weeks. Full physical recovery — including resolution of wound oedema, return of nipple sensation, and resumption of strenuous activity — is typically complete by 4–6 weeks post-operatively.