Duct Ectasia

What it is

Duct ectasia is the dilation of the ducts behind the nipple, with the buildup of thick discharge and surrounding inflammation. It is a benign change, more common during perimenopause and postmenopause and in women who smoke. It may cause no symptoms or produce greenish, dark or thick nipple discharge, tenderness and redness of the areola, nipple retraction and, sometimes, a hardening behind the areola that can be mistaken for a lump. Diagnosis is made with a clinical exam, ultrasound and mammography, which show the dilated ducts; biopsy is reserved for cases with doubt. In most cases, treatment is only supportive — warm compresses, pain relievers and antibiotics if there is infection. Surgical removal of the ducts is considered when symptoms persist or recur.

Most common symptoms

• Thick, greenish, dark or sticky nipple discharge
• Tenderness, pain or redness of the areola
• Recent-onset nipple retraction or inversion
• Hardening behind the areola, which can resemble a lump
• Recurring inflammation around the nipple
• No symptoms, found on mammography or ultrasound

Causes and risk factors

• Natural aging of the ducts, during perimenopause and after menopause
• Smoking, the main factor associated with the inflammatory forms
• Buildup of thick secretion that dilates and blocks the duct
• Chronic inflammation around the ducts, with infection in some cases
• Long-standing nipple inversion, which hinders drainage

How it is diagnosed

The assessment includes the history of symptoms, a clinical exam of the breasts, and observation of the discharge and the nipple. Ultrasound, performed on site, shows the dilated ducts behind the areola with thick content; mammography, depending on age, can reveal the ducts and typical small calcifications. Since nipple retraction and hardening behind the areola also occur in other conditions, aspiration or ultrasound-guided biopsy is indicated whenever the imaging leaves doubt.

How we treat it at Femi Saúde

In most cases, duct ectasia does not need surgery. Treatment is supportive: warm compresses, pain relievers or anti-inflammatories during painful periods, and antibiotics when there are signs of infection. Quitting smoking is a central recommendation, since smoking is linked to the inflammatory forms and to recurrences. The breast health team at Femi Saúde monitors the patient with periodic clinical exams and ultrasound and, if an abscess forms, performs drainage by ultrasound-guided puncture. Surgical removal of the affected ducts is considered when the discharge or inflammation persists or recurs. The plan is individualized according to symptoms and age.

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