Ductogram

April 10, 2025

This page was reviewed under our medical and editorial policy by Hannah Chang, M.D., assistant professor, and Susan Yost, Ph.D., staff scientist, Department of Medical Oncology & Therapeutics Research, City of Hope^® Cancer Center Duarte

A ductogram, also known as ductography, galactogram or galactography, is a specialized imaging test that lets the care team see inside the breast’s milk ducts. This procedure uses mammography and a contrast material injection to create detailed pictures.

It is often recommended when a patient has a bloody or clear nipple discharge, even if a mammogram appears normal. The ductogram helps pinpoint any issues within the ducts that might need attention.

What Is a Ductogram?

A ductogram is an X-ray procedure that creates detailed images of the milk ducts in the breast. During the procedure, a very thin tube called a catheter is gently inserted into the nipple, and a small amount of dye is injected into the milk duct. This dye helps the duct show up clearly on the X-ray, allowing the care team to see any abnormalities.

The ductogram may help diagnose several conditions, including papillomas (small, wart-like growths within the milk duct), fibrocystic changes or even breast cancer. In some cases, a small sample of the fluid may be collected during the procedure to check for infection or cancer cells.

While mammograms, breast ultrasounds and magnetic resonance imaging (breast MRIs) are appropriate tools for looking at the breast, a ductogram provides a clearer view of the inside of milk ducts. This makes the ductogram a valuable test when identifying the cause of nipple discharge or other concerns related to the milk ducts. This detailed view may help the care team make an accurate diagnosis and decide on a course of treatment or monitoring.

Preparing for Galactography

Preparing for a ductogram involves a few simple steps. Patients are advised not to squeeze the nipple before the exam because the doctor needs to see where any fluid is coming from to perform the test accurately.

On the day of the exam, patients should avoid wearing deodorant, talcum powder or lotion under their arms or on their breasts, as these may show up on the X-ray as calcium spots. Before the examination, patients will be asked to remove all jewelry and clothing above the waist and will be provided with a loose-fitting gown that opens in the front.

Patients should inform their doctor about all medications they take and any allergies, especially to iodine contrast materials. They should also mention any recent illnesses or medical conditions. Patients should notify the doctor or X-ray technologist if there is any chance of pregnancy.

The Ductography Procedure

The ductogram procedure is performed using a mammography unit designed specifically for breast X-rays. This unit includes a device to hold and gently compress the breast while allowing the technologist to capture images from different angles.

For the procedure, the patient is either seated or lying down face up with the breast exposed. The nipple is gently cleansed, and a small amount of fluid is gently squeezed out to identify the duct with discharge. 

A tiny plastic or blunt-tipped tube (catheter) is then inserted into the milk duct. In some cases, a warm towel may be placed on the breast to make the duct more visible, making it easier to insert the catheter. This may be uncomfortable for the patient, but it usually is not painful. Once the catheter is in place, a small amount of contrast material is injected into the duct.

Then a mammogram is performed. Patients must remain very still and may be asked to hold their breath for a few seconds to prevent blurring the images. The technologist steps behind a wall or into the next room to activate the X-ray machine. If needed, a second injection and mammogram may follow.

The entire procedure typically takes 30 minutes to an hour. Afterward, the technologist may ask the patient to wait briefly while the radiologist ensures all necessary images have been captured.

Ductogram Results

After the ductogram, a radiologist carefully analyzes the images. The radiologist then sends a signed report to the patient’s primary care or referring physician, who will discuss the results with the patient. In some cases, the report may be provided directly to the patient at the time of the exam.

The results from a ductogram may reveal important information about the milk ducts, including the presence of intraductal papillomas, which are small, wart-like growths inside the ducts. While a single papilloma generally does not increase the risk of breast cancer unless there are other changes, having multiple papillomas may slightly raise that risk.

The ductogram may also detect small cancerous or noncancerous masses that other imaging methods might miss, allowing for early intervention if necessary. If the ductogram identifies any potential issues, the doctor may recommend a follow-up exam. This follow-up might involve additional imaging to obtain more detailed views or to monitor any changes over time.

Benefits, Risks and Limitations

A ductogram offers several benefits. Providing a detailed view of the milk ducts may help identify the exact location of any tumors, assisting surgeons in planning precise interventions. Another advantage is that no radiation remains in the body after the X-rays.

However, like all medical procedures, ductography carries some risks. There is a slight chance of cancer from radiation exposure. However, the amount of radiation used is minimal, and the benefits of an accurate diagnosis usually outweigh this risk.

There is also a possibility of injury to the duct during catheter placement or contrast injection, though this typically heals on its own. Other risks may include the potential for infection, such as mastitis, and the chance of missing the area of concern if the tube is placed in the wrong duct.

Limitations of a ductogram include the possibility that it is unable to be performed if no discharge is present at exam time. Additionally, some ducts may be too small to dilate, making it challenging to obtain accurate results. The procedure is slightly more invasive than other imaging methods. There is also a small chance of false-negative results if the incorrect duct is imaged, and not all breast tumors occur within the ducts, so some may go undetected by this method.