Mammary duct ectasia

What it is

Duct ectasia is dilatation of the major subareolar ducts. These ducts dilate and shorten during involution, and by the age of 70, 40% of women have substantial duct dilatation or duct ectasia, so it is a disease of peri or post menopause women.

The nipple inversion is put down to recurrent remitting inflammation that causes fibrosis: that is why the nipple inverts, and it pulls the nipple inwards. If a duct ruptures it may cause local inflammation, sometimes referred to as plasma cell mastitis.

Causes and risk

The risk factors given for it are age, smoking and DM.

How it presents

• Nipple discharge, usually cheesy, though it could also be brown or bloody.
• Nipple retraction, which is slit-like, and this is what separates it from the nipple retraction of breast cancer.
• A palpable mass, hard or doughy.

The nipple inversion may be bilateral. Duct ectasia is only one of the breast conditions that may present with nipple discharge; the others are cyst, fibro cyst, DCIS, malignancy, mastitis and papilloma.