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Dr. Herb Goldberg
Dr. Herb Goldberg, Board Certified Plastic Surgeon
Category: Plastic Surgery
Satisfied Customers: 299
Experience:  35 years experience in cosmetic and reconstructive plastic surgery. Certified by the American Board
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RE Duct Ectasia I have just come back from an NHS hospital

Resolved Question:

RE Duct Ectasia

I have just come back from an NHS hospital appointment where I was informed that I have Duct Ectasia and that, while it was suggested previously that surgery would be offered, I would not be receiving any treatment.  

The consultant made rather a big deal about the risks of surgery but now, researching at home, there seems to be a huge discrepancy between his claims and those of private cosmetic surgery clinics.  Namely, the private clinics cite the procedure as being quick, low risk and with a short recovery time and minimal scarring. 

My NHS consultant did also refer to money and resources on more than one occasion and this leaves me wondering: was he insinuating the surgery was higher risk than it is in reality to 'explain away' the fact I am essentially not a 'cost effective' use of NHS resources?  Or alternatively is the private sector over simplifying and down-playing any risks in order to attract customers?

Sub-questions:

Many of the private clinics suggest that even a grade 3 inversion can be corrected by making an incision at the base of the nipple so that there is essentially no scarring, yet other resources suggest it would be nescesary to make a large incision around the areola, remove some of the epidermis above the areola, before then reattaching the areola to a new higher position in order to provide structure and support and to prevent a reoccurrence of the inversion.

I am aware that there are other techniques too, but I wonder:
• Would it be wise to try to pursue NHS treatment, or are private clinics more likely to be using cutting-edge techniques?
• How could I ensure I get the best treatment?

Any other ralated information, advice or links to useful resources would be welcomed.

Many thanks.
Submitted: 3 years ago.
Category: Plastic Surgery
Expert:  Dr. Herb Goldberg replied 3 years ago.

Dr. Herb Goldberg :

Thanks for your question. Duct ectasia of the breast often causes nipple inversion. It may be associated with difficulty in breast feeding a newborn. It is not known to cause any other problem other than those of occassional mastitis or fibrocystic disease. It can be self-limiting, in which case it should improve in a few months. You must be certain there are no breast lumps under the nipple or elsewhere on the breast. A mammogram maybe indicated if you are symptomatic or if a lump is felt. If there is inflammation, you will or should receive treatment (usually antibiotics). If there is no other problem but inversion of the nipple that continues to be a problem indicating the ducts that drain into the nipple are blocked or unopened, then there is a procedure to correct this problem. The procedure is usually done in an outpatient surgical facility under a local anesthesia. A small incision can be made in the areola under the nipple and the ducts are divided and separated from the nipple which is held in an "out"position and dressed to hold for a few days. Most plastic surgeons are familiar with this condition and offer this or similar procedures to help your condition. There is little noticeable scarring. The NHS Dr. may have thought your condition would not be permanent and therefor no surgery was necessary. If you continue to have inversion, then I advise you consult with a board certified plastic surgeon who will examine the problem and determine with you what can be done and what complications can occur. If both breasts have ductal ectasia then breast feeding probably cannot occur if you are considering this. Let me know if you have any other questions concerning this problem and if this answer helps answer your question, please click the "accept" button.

Dr. Herb Goldberg :

If there is no nipple inversion, inflammation or lumps in the breast, then no treatment or surgery needs to be performed.

Customer: It is effecting only my right breast and the nipple is grade 3 inversion. I have problems with nipple hygine as a result, as well as often experiencing generalised discomfort and some localised pain. There is a lump underneath the nipple but the NHS Dr. says that this is part of the chronic inflammation they have detected. I have had antibiotics but this has not improved the situation. The discharge I get changes (possibly hormone related) but it usually smells 'cheesy' and 'off' and is creamy in colour and texture. I cannot 'express' the discharge, but often it builds up and I have to 'clean it out' between 1-3 times a day. I have had problems with discharge from both nipples since age 13 (I was told it was likely "hormone related" and "should settle down"...bearing in mind I am now 28 with no improvement), although its prominence fluctuates. I am not concerned with breast feeding as I have no intention of having children. A biopsy was taken of the lump and the result was that it was benign, but they did not explain the details when pressed as to what the difference was between the lump and the inflammation. I had an ultrasound but not a mammogram during my first consultation. The right nipple has been permanantly inverted for about 10-12 months, although before that it was a 'stage 2' for many years.
Customer: Only my right nipple is inverted, although I have had problems with discharge from both since age 13 to varying degrees.
Customer: (Sorry, last line was added as I thought I'd 'lost' the proceeding text and thought I had to start over!)
Customer: Considering the discomfort, pain, longevity of the inversion and hygine issues, should I not have been an NHS candidate for surgery? In your opinion should I contents the issue with the NHS if it appears to be funding related?
Dr. Herb Goldberg :

I am glad to hear that the lump was benign. I believe that the Grade 3 inversion needs surgical attention because of the problems you are having. If the lump is small, it should be removed and the nipple separated from the tissue below. The surgeon must make sure that the nipple has good circulation so that it will survive.

Dr. Herb Goldberg :

You may have fibrocystic disease and the discharge is milky and related to hormones and/or sebaceous (natural oil glands in the skin and breast). You may need to see an Endocrinologist if the discharge and lumps continue. I advise you to express your concerns to the NHS physician and ask to see a Dr. or Surgeon who may be able to help this condition. If the doctors feel that the surgery is too dangerous for you or that it may result in nipple loss, sometimes there are other methods such as "suction apparatus" that can be applied and monitored, that can sometimes be used. Some breast or plastic surgeons may know about alternatives. You deserve to have this condition treated as best as possible. Best of luck in finding a solution to your "problem".

Dr. Herb Goldberg, Board Certified Plastic Surgeon
Category: Plastic Surgery
Satisfied Customers: 299
Experience: 35 years experience in cosmetic and reconstructive plastic surgery. Certified by the American Board
Dr. Herb Goldberg and other Plastic Surgery Specialists are ready to help you
Expert:  Dr. Herb Goldberg replied 3 years ago.
Hi,
I hope that your problem is improoving and that your questions have been satisfactorily answered.
I hope we have helped and wish you the best. If any other questions, let me know.

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