Treatment of Mammary Duct Fistula by Fistulectomy and Saucerization

Abstract

This study was designed to assess the efficacy and long-term outcome of fistulectomy and saucerization for treatment of mammary duct fistulae. Mammary fistula is a chronic condition that represents the final step in what has been termed "mammary duct associated inflammatory disease sequence." The treatment is primarily surgical and may include healing by secondary intention or primary closure with or without antibiotics. Reported series are small and often include variable surgical strategies applied without consistency. A consecutive series of 53 patients who had 59 mammary duct fistulae were treated by fistulectomy with saucerization. The median age was 32 years. Wounds were allowed to heal by secondary intention and antibiotics were not used. We reviewed the case records to establish the incidence of recurrent fistula and the time to complete healing. The long-term cosmetic outcome was determined by a postal survey. After a median follow-up of 6 years there had been no relapse in 92%. There was significant delay in healing in six cases (range: 10 to 30 weeks). Thirty-eight patients (83%) gave a definite history of regularly smoking between 10 and 20 cigarettes a day. Two thirds of the patients were either pleased or satisfied with the final cosmetic result of the surgery, but more than 90% said that it left them with some distortion of the nipple. Fistulectomy and saucerization achieves long-term cure in the majority of patients with mammary duct fistula, but it results in some degree of distortion of the nipple. The strong relationship between smoking and the occurrence of mammary duct fistulae is again demonstrated.

Surgical treatment of recurring subareolar abscess using oncoplastic techniques

“…Beechey-Newman et al published a series of 53 patients treated for periareolar abscess by laying open the abscess with secondary healing. Of twelve patients who had an aesthetic evaluation a posteriori, seven patients (62%) rated their result as mutilating, 11 of them found their nipple disharmonious (92%), and 4 (34%) felt that their breast had an overall unattractive appearance [6]. In the study of Li et al, 83% of patients who received nipple resection resulting in cure of their disease were satisfied with the cosmetic result [18].…”

“…Menguid et al used a radial incision without excision of the fistula and allowed the incision to heal secondarily after excision of the lactiferous ducts involved in the abscess [3]. Beechey-Newman et al performed a fistulectomy associated with a wide resection of dilated lactiferous ducts and secondary healing, and obtained a success rate at 6 years follow-up of 92% [6]. Almasad used a circumareolar incision with combined fistulectomy and glandular excision.…”

“…The tendency to recur is favored by both the inflammatory response to debris within the glandular tissue and to reinfection by pathogenic or commensal microbial flora [1][2][3][4][5]. The fistula initially is lined by granulation tissue, but in chronic cases, a keratinized epithelium lines the fistulous tract preventing spontaneous healing [6]. These abscesses are different from and should not be treated like acute breast abscess in nursing mothers.…”

“…Multiple recurrences with fistula at the same site pose a therapeutic problem for the surgeon and a medical and psychological problem for patients [6,7]. Some studies have reported medical therapy with antibiotics [5,7].…”

Efficacy of intralesional triamcinolone injection in the treatment of mammillary fistula: a prospective study

“…The main problem is recurrence (6,7) and the resulting reoperations. The best management of MF remains a great challenge for clinicians.…”