For which condition is total duct excision primarily indicated?

Total duct excision is primarily indicated for chronic periductal mastitis. This condition involves inflammation and infection of the ducts in the breast, often associated with abnormalities in the duct lining and may lead to the formation of abscesses. In cases where conservative treatment does not alleviate symptoms or in recurrent instances, surgical intervention is required to remove the affected duct system entirely, thus alleviating symptoms and preventing further complications.

In contrast, adenocarcinoma of the breast typically necessitates a different surgical approach, such as mastectomy or lumpectomy, depending on the stage and extent of the disease. Fibrocystic breast changes are usually managed with conservative treatments, and painful breast cysts are typically treated with aspiration rather than duct excision, as these conditions involve different underlying processes and treatment goals.