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2005 by the Societe Internationale de Chirurgie World J Surg (2006) 30: 6368Published Online: 12 December 2005 DOI: 10.1007/s00268-005-0116-8Treatment of Mammary Duct Fistula by
Fistulectomy and SaucerizationN. Beechey-Newman, MS, A. Kothari, MS, D. Kulkarni, MS, MRCS, H. Hamed, PhD,I. S. Fentiman, MD, DScHedley Atkins Breast Unit, Guys Hospital London SE1 9RT, London, United KingdomAbstractThis study was designed to assess the efficacy and long-term outcome of fistulectomy andsaucerization for treatment of mammary duct fistulae. Mammary fistula is a chronic condition thatrepresents the final step in what has been termed mammary duct associated inflammatorydisease sequence. The treatment is primarily surgical and may include healing by secondaryintention or primary closure with or without antibiotics. Reported series are small and often includevariable surgical strategies applied without consistency. A consecutive series of 53 patients whohad 59 mammary duct fistulae were treated by fistulectomy with saucerization. The median agewas 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 tocomplete healing. The long-term cosmetic outcome was determined by a postal survey. After amedian follow-up of 6 years there had been no relapse in 92%. There was significant delay inhealing in six cases (range: 10 to 30 weeks). Thirty-eight patients (83%) gave a definite history ofregularly smoking between 10 and 20 cigarettes a day. Two thirds of the patients were eitherpleased or satisfied with the final cosmetic result of the surgery, but more than 90% said that it leftthem with some distortion of the nipple. Fistulectomy and saucerization achieves long-term cure inthe majority of patients with mammary duct fistula, but it results in some degree of distortion of thenipple. The strong relationship between smoking and the occurrence of mammary duct fistulae isagain demonstrated.In 1953 Hedley Atkins proposed a new name for a
condition that he called mammillary fistula.1 He described a chronic infection comprising one or more subcutaneous abscess in the region of the areola, whichdischarged spontaneously, appeared to resolve, but onlyto recur again. He recognized that this was a fistula into alactiferous duct and proposed that this required similartreatment to a fistula-in-ano by laying open and saucerizing the fistulous tract. It was also thought that terminalductal obstruction produces a proximal diverticulum,which re-infected...