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What is a galactogram?
Galactography (also called ductography) is a procedure done to image the ducts within the breast. It requires the use of contrast media (x-ray dye) and mammography (x-ray of the breast with compression.) It is performed by trained and experienced radiologists.
Why is a galactogram done?
This exam is performed to investigate the cause of a bloody or clear nipple discharge from the breast. Discharge that is yellow, green, milky, black or gray is usually not cause for concern; therefore galactography is not indicated for this. It is best to dab the discharge with a white gauze or cloth to determine the actual colour.
Bloody or clear nipple discharge may be caused by several reasons such as:
- enlarged ducts (duct ectasia)
- trauma to the breast
- a haemorrhaging cyst
- a cancerous lesion
- a papilloma
It is important for your doctor to know if bloody or clear discharge occurred spontaneously (on its own), following an injury, during compression, or only expressed by pressure on the nipple. The most common cause of bloody or clear discharge is due to a papilloma. A papilloma is a wart-like tumor with branching and a stalk that has grown inside the duct. They are non-cancerous, but must be surgically removed as the only way to make the final diagnosis of a lesion is to have a pathologic analysis done. A galactogram is done to determine if there is a lesion and its location within the breast. This information is required for the surgeon so that it can be removed.
How is the procedure done?
There is no preparation for a galactogram other than we ask you not to squeeze or express any fluid from your nipple before your appointment. There may only be a little bit of fluid left and this is needed for the exam to identify which duct the discharge is coming from. There are several ducts opening to the nipple (there may be as many as 20-25).
- Before we begin the exam, the radiologist will explain the procedure, answer any questions you may have, and obtain your consent to proceed.
- The radiologist will then try to express some discharge or ask you to express the discharge. If fluid does not readily present itself, the radiologist will gently massage your breast or warm towels may be placed on your breast as this sometimes encourages the discharge to release.
- If discharge is present, you will be reclined in our chair, your nipple will be cleaned with some antiseptic solution, and a very small blunt ended probe will be gently inserted into the discharging duct. If the opening to the duct is very small, some gentle pressure may be used to help ease the probe in. It is never forced in. There is usually no discomfort.
- Once the probe is in place, a small amount of dye is injected through the tube attached to it. Again, there should be no pain; however, you may feel slight fullness in the breast.
- The probe will then be taped to your breast and we will carefully sit you up to do a picture of the nipple region and the ducts leading to it. More contrast may be injected and slightly different images obtained.
- The probe is then removed and the technologist will give you a wet cloth to wipe any residual contrast off your breast (as it is sticky.) The remainder of contrast will discharge on its own and some may be absorbed by your body.
- The radiologist will then study the images and may decide to have an ultrasound done following this procedure. The results may be communicated to you the same day. Your family physician will receive the report and arrange any further management.
How long does the procedure take?
You can expect to be here for approximately 30-45 minutes. This all depends on how easily the duct can be identified and cannulated (probe inserted).
What are the limitations?
The biggest limitation is not being able to express any fluid from the duct. If we cannot identify which duct the discharge is from, we are unable to do the exam (we do not want to cannulate the wrong duct).
- If a duct is very small we may not be able to dilate it enough to insert the probe.
- If you have severe allergies, especially to x-ray dye, you may require pre-medication. Very little contrast is actually absorbed, but this will be discussed with the radiologist during time of consent.
*Please inform us if you have had a reaction to x-ray dye in the past.*
- If you have an inverted nipple, it may be very difficult to identify the duct or insert the probe. However we will still make the attempt.
- The success of the galactrogram may be compromised if you have had previous surgery around the nipple which may have affected the ducts.
What happens if there is no discharge the day of the exam?
If we cannot express any discharge on the day of the exam or if you have not had any discharge for quite some time, the exam may be postponed to a later date. We will ask you to contact our office if the discharge should reoccur.
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