What Is a Ductogram (Galactogram)?

What to expect when undergoing this test

breast ducts and lobes in cross section view
What is a ductogram and what happens during the procedure? What conditions may be diagnosed?. Illustration © Pam Stephan

A ductogram (galactogram) is a type of medical imaging used to view your breast ducts. It can be helpful in finding the cause of nipple discharge. A ductogram involves mammography and use of a contrast agent that gets injected into the breast, like during a breast MRI. A fluid sample is extracted and sent for further testing.

Purpose of Test

Typically, your doctor will order a ductogram if you have clear or bloody nipple discharge and no abnormalities showed up on a mammogram.

Several abnormal conditions involving the milk ducts may be diagnosed with the help of a ductogram, including:

A ductogram also can help direct your surgeon to the ducts that need to be removed, for example, during surgery for intraductal papillomas or ductal carcinoma (breast cancer).

In addition, for those with intraductal carcinoma in situ (DCIS), intraductal therapy by way of a ductogram may offer a less invasive method of preventing the spread of cancer while minimizing breast trauma.

A ductogram is not generally used if the discharge is milky, gray, green, or blue-green, as those colors are not normally indicative of a problem. It's also not used when discharge comes from both breasts in women who haven't had children, as that's most often caused by a pituitary problem or a drug side effect.

Limitations

A ductogram does have some limitations that you should be aware of and that your doctor will consider:

  • If you don't have any discharge when you go for the ductogram, the test can't be done and you may need to re-schedule it.
  • Some of your ducts can't be dilated because they're too small.
  • The test cannot detect a tumor that lies outside of the duct, so a negative result doesn't mean you're cancer-free.

Risks and Contraindications

Ductography does come with a few risks that you and your doctor should weigh against its benefits. Risks include:

  • Exposure to radiation: Exposure to too much radiation can slightly increase your risk of cancer. However, the amount used for this test is small and not considered dangerous.
  • Injury to the duct: Injury can occur when the catheter is placed in the duct to deliver the contrast agent or when the material itself is injected. This is usually minor and heals on its own.
  • Infection: In rare cases, mastitis (infection of the breast) may develop as a result of this procedure.
  • Allergy: It's possible (but rare) to have an allergic reaction to the contrast materials used in this test. Let your doctor know if you've previously had an allergic reaction when undergoing imaging.

If you are or could be pregnant, make sure to let your doctor and the X-ray technician know. They can take special precautions to protect your baby from radiation. Depending on the reason for the ductogram, your doctor may want to delay the test until after your baby is born.

Before the Test

On the day of your ductogram, don’t use talcum powder, deodorant, or skin lotion. These can interfere with the imaging results.

Don't squeeze your nipple before the exam, as that may cause the fluid to come out, leaving little to none left for the test.

Timing

A ductogram typically takes between 30 and 60 minutes. Be sure you arrive early enough to get checked in before your appointment time. You'll also need to change into a gown before the procedure and get dressed again afterward.

You shouldn't need to have the test at a specific time of day.

Location

A ductogram may be performed at a radiology or breast health clinic.

What to Wear

Dress for comfort, as you will be asked to remove all your clothing from the waist up. Choose a loose top that is easy to remove and put back on. If you can, avoid wearing an underwire bra, since you will be having a mammogram with compression as part of this exam. Your breast may be a bit sore after the exam, and a soft-cup bra may be more comfortable.

Food and Drink

You should be able to eat and drink normally before and after the test.

Cost and Health Insurance

If you have health insurance, talk to your carrier to see whether they'll cover a ductogram and what out-of-pocket expenses you may have to take care of. Your doctor's office and the facility where it's performed should be able to tell you how much the test will cost whether you have insurance or not.

What to Bring

Make sure you have your insurance card and any written orders your doctor may have given you. The facility may also want to see any prior breast images you've had done.

If you're anxious about the test or the possible results, you may want to have someone drive you to and from the appointment. They likely won't be able to be with you during the ductogram itself, though, because of the possible radiation exposure.

During the Test

Ductogram is performed using a mammogram, dilators (small wires), a small catheter, and a tube that injects contrast material into the duct.

Pre-Test

In an exam room, you will lie down on the table and uncover the breast that has the nipple discharge. Your nipple will be cleaned and sterilized so that it's easier to find the duct that is leaking.

Throughout the Test

While the ductogram is the imaging test, your doctor will begin by finding what's called your trigger zone and taking a fluid sample.

Identifying the Trigger Zone

Your doctor will press on your breast to find the area that will consistently cause nipple discharge when pressure is applied. If your ducts are going to be surgically removed, knowing this trigger zone will be helpful to your surgeon.

A sample of your discharge fluid will be taken and tested. The color and thickness of the discharge will be noted, and a test strip may be used to test for blood.

Contrast Fluid Delivery

Once the duct has been identified and the nipple discharge sampled, your doctor will use magnifying glasses to see the specific duct. A very small and flexible tube, called a cannula, will be gently inserted right into this duct in your nipple. Gentle pressure will be used, which should not produce any pain. If it hurts, let your doctor know right away.

The tube will be taped in place and connected to a small syringe filled with contrast agent. This will be slowly injected into your milk duct. If you've breastfed, you'll recognize the feeling—it's much like the milk let-down. Your ducts will then feel full and you may feel pressure inside the breast that's uncomfortable. If it becomes painful, say something. Your doctor may be able to ease the pain with anesthetic gel or warm compresses.

With the tube still in place, your doctor may use an ultrasound machine to see if enough contrast fluid has been injected. When your duct is full enough, you'll move to the mammogram machine for the imaging.

Imaging

Some doctors will remove the tube and put tape over your nipple to keep the contrast agent inside your duct, and some doctors will leave the tube in position.

Your breast will be positioned as for a mammogram, and pressure will be applied (but less than you'd expect from a regular screening) while the image or images are taken. You may be repositioned between images so your doctor can look at things from multiple angles.

Post-Test

Once the test is over, any tubes or tape that are still attached to you will be removed. Then you can get dressed and go home.

After the Test

As with a mammogram, you may have some lingering tenderness after the test. You should be able to manage this with over-the-counter pain relievers and/or heat. If it doesn't go away or if you develop any other side effects, contact your doctor.

Interpreting Results

Your radiologist will carefully study the images from your ductogram and write a report on the results. Your doctor or radiologist will contact you about what was found, giving you a diagnosis and recommendation for follow-up.

Follow-Up

What follow up is required depends on the findings and diagnosis. It may be that you need further testing, or your doctor may be ready to discuss treatment options.

A Word From Verywell

Nipple discharge is common and, according to studies, it's associated with non-cancerous conditions between 80% and 95% of the time. While it can be difficult, try not to fixate on the worst-case scenario as you prepare for a ductogram and wait for the results. If you are worried, talk to your doctor about the nature of your discharge, other symptoms you may be experiencing, and the possible causes of them. The answer may go a long way toward putting you at ease.

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Article Sources

  1. Berna-Serna J, Torres-Ales C, Berna-Mestre J, Polo L. Role of Galactography in the Early Diagnosis of Breast Cancer. Breast Care. 2013. 8(2):122-6. doi:10.1159/000350779.

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