Milk duct excision - Hadfield’s procedure - by a consultant breast surgeon.
The definitive operation for benign multi-duct nipple discharge and recurrent subareolar abscess - done properly, with full triple assessment first, and honest conversations about nipple appearance and breastfeeding beforehand.
Indicative pricing
What private duct surgery costs in London.
Indicative ranges across UK private providers.
In short
£3,500–£6,000, home same day or after one night.
| Procedure | Indicative range | Typical duration | Discharge |
|---|---|---|---|
| Central duct excision (Hadfield’s) under GA | £3,500–£6,000 | 60–90 min | Day-case or 1 night |
| Central duct excision under LA + IV sedation | £3,000–£5,000 | 45–75 min | Same day |
| Microdochectomy (single-duct) | £2,800–£4,800 | 45–60 min | Same day |
| Subareolar abscess drainage + fistulectomy | £2,200–£4,000 | 30–60 min | Same day |
| Triple assessment (clinic + imaging + cytology) | £600–£1,200 | Half-day | Same visit |
| Consultation only | £220–£420 | 30 min | Same visit |
Prices vary by clinic, by which breast surgeon does the case, by the anaesthetic chosen, and by whether triple assessment has already been done privately or via the NHS.
The problem
The right operation, the right surgeon, the right conversation first.
Central duct excision is a small operation with permanent consequences - nipple appearance, sensation and future breastfeeding. We only book it once triple assessment is done and you understand what is being traded for what.
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Sure it is multi-duct?
Single-duct discharge is a microdochectomy - better cosmesis and lactation preserved. We do not do more than is needed.
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Recurrent abscess?
Stopping smoking first is not a nice-to-have - it is the single biggest determinant of whether surgery works.
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Want it done properly?
A named consultant breast surgeon on the ABS register, in a proper theatre, with histology reported by a breast pathologist.
When it helps
When central duct excision is the right step.
The situations we see most, plus the red flag that means a two-week-wait cancer referral, not a benign duct operation.
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Multi-duct pathological discharge
Spontaneous discharge from multiple duct orifices - bloody, serous or coloured - after benign triple assessment.
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Recurrent periductal mastitis
Repeated painful subareolar inflammation, strongly linked to smoking, that will not settle with antibiotics alone.
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Recurrent subareolar abscess (Zuska’s)
Painful subareolar abscesses that keep coming back, often with a mammillary fistula - definitive treatment after drainage fails.
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Symptomatic duct ectasia
Dilated ducts causing pain, discharge or a subareolar mass - asymptomatic ectasia is usually just observed.
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Failed microdochectomy
Single-duct surgery has been done but the discharge has come back - central excision removes the whole duct system.
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Patient preference to end discharge
Benign multi-duct discharge that is not dangerous but is affecting your life - surgery is a reasonable choice.
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Nipple inversion with discharge
Chronic nipple inversion with recurrent discharge or infection can be addressed at the same operation.
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Red flag: suspicious features
A hard lump, skin change, single-duct bloody discharge in an older woman, or abnormal imaging is a two-week-wait referral - not a benign duct operation.
Procedure options
Central excision is not the only option.
What each option on the table actually involves - and which fits which problem.
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Central duct excision (Hadfield’s)
The standard operation for multi-duct disease. The nipple-areola complex is lifted and all major ducts are divided at the nipple base.
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Total duct excision (Urban procedure)
A more extensive core of subareolar tissue is removed - reserved for extensive disease or repeat surgery.
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Microdochectomy (single-duct)
For single-duct pathological discharge. Only the affected duct is removed - better cosmesis, and lactation may be preserved on that side.
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Central excision under GA
Asleep in a proper theatre with an anaesthetist - the most common choice for a 60–90 minute operation.
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Central excision under LA + IV sedation
Local plus light sedation for suitable patients who would rather avoid a general anaesthetic.
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Subareolar abscess + fistulectomy
For an acute infection, drainage and fistula excision come first - definitive duct excision is planned once the inflammation has settled.
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Nipple reconstruction at the same visit
Where nipple inversion is expected or already present, the surgeon can address the cosmesis at the same operation.
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Consultation only
Safety and recovery
What to expect afterwards - honestly.
Central duct excision is a safe day-case operation, but the trade-offs are real - nipple appearance, sensation and permanent loss of breastfeeding on that side.
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Nipple inversion is expected
Dividing all major ducts changes the shape of the nipple. Some degree of nipple inversion afterwards is common - this is discussed honestly before you consent.
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Loss of nipple sensation is common
The small sensory nerves to the nipple can be disrupted. Reduced or altered sensation is common; complete numbness is less common but possible.
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Permanent loss of breastfeeding
Because all major ducts are divided, you will not be able to breastfeed from that breast afterwards. This matters if you may want children - say so before we plan surgery.
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Smoking cessation is not optional
For periductal mastitis and recurrent abscess, continued smoking is the single biggest cause of wound problems and recurrence. Many surgeons will not operate until you have stopped.
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Bleeding, infection, wound problems
Small collections, wound infection or wound breakdown can happen - usually managed with dressings and antibiotics, occasionally needing a return to theatre.
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Nipple necrosis is rare
When the nipple-areola blood supply is preserved carefully, nipple necrosis is rare - but you should know it is a recognised risk.
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Fat necrosis and a lumpy scar
A firm area under the scar is normal for months. Fat necrosis can occasionally produce a persistent lump that needs re-imaging.
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The scar is well hidden
A periareolar incision follows the natural border of the areola, so the scar usually settles and fades to a fine line over 6–12 months.
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Red flags
Fever, spreading redness, heavy bleeding or a rapidly enlarging swelling in the days after surgery are not normal - call the clinic or A&E the same day.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever version of duct surgery was done, the note the breast surgeon sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the note and the histology before your review, just ask.
- 01 Header
Indication and operation performed
Why the operation was done - multi-duct discharge, recurrent abscess, duct ectasia - and whether it was a Hadfield’s central excision, total duct excision or microdochectomy.
- 02 Technique
Anaesthetic and surgical technique
Whether it was under GA or LA + sedation, the incision used, which ducts were divided, and whether any fistula tract was excised.
- 03 Findings
Macroscopic findings and specimen
What the surgeon saw at operation - dilated ducts, inspissated secretions, an abscess cavity, or a mass - and what was sent to histopathology.
- 04 Impression
Histology, recovery and review
Read this first: the histology result (usually benign duct ectasia or periductal mastitis), what it means, when to come back, and any further steps.
Recognised by major UK insurers
Cover for benign breast surgery varies by insurer and by indication - usually funded when medically indicated (pathological discharge, recurrent abscess).
Frequently asked
Everything we get asked about milk duct excision.
Quick answers on nipple appearance, sensation, breastfeeding, cost and recovery.
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What is a milk duct excision (Hadfield’s procedure)?
It is an operation that removes the major milk ducts under the nipple through a small cut at the edge of the areola. It is the standard treatment for benign multi-duct nipple discharge and for recurrent subareolar (periductal) inflammation and abscess.
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How is it different from a microdochectomy?
A microdochectomy removes only one affected duct - the option when discharge comes from a single duct opening. Hadfield’s central duct excision removes all the major ducts and is chosen when the problem involves multiple ducts or when a subareolar abscess keeps coming back.
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Will I still be able to breastfeed afterwards?
No - not on that side. Because all the major ducts are divided at the nipple, that breast can no longer produce milk to the nipple. The other breast is unaffected.
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Why is smoking such a big deal for this operation?
Periductal mastitis and recurrent subareolar abscess are strongly linked to smoking. Continued smoking dramatically increases the chance the disease comes back and the wound will not heal cleanly. Many breast surgeons will not offer elective duct surgery until you have stopped.
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Will my nipple look different afterwards?
Usually yes, at least a little. Because the ducts that hold the nipple out are divided, some degree of nipple inversion is common. Sensation may also change. We talk this through - with photos - before you consent.
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How much does private central duct excision cost in London?
Roughly £3,500–£6,000 under GA and £3,000–£5,000 under LA + sedation. A single-duct microdochectomy is £2,800–£4,800. Triple assessment beforehand is a separate £600–£1,200.
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How much time off work do I need?
Most patients take 3–7 days off, and can return to office work within a week. Avoid heavy lifting, gym and running for 2–3 weeks, and wear a soft supportive bra day and night for the first fortnight.
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Does the operation cure the discharge?
For benign multi-duct discharge, central duct excision resolves the discharge in more than 95% of cases. For recurrent subareolar abscess and periductal mastitis, cure rates are 80–90% - provided you have stopped smoking.