This study evaluates microdochectomy as a means for diagnosis and treatment of patients with pathological nipple discharge (PND) but with benign or normal imaging and cytology. From 1999 until 2006, in St. Mary's Hospital, 76 patients with the aforementioned condition underwent microdochectomy because of the presence of epithelial cells on nipple smear or for symptomatic relief. Most of the patients had intraductal papillomas (48.7%), duct ectasia (15.8%) or a combination of the two (13.2%). Other benign causes occurred in 11.8% of the patients. Eight patients, including one who was operated for symptomatic relief, had cancer. Of those patients with benign condition, 98% had symptomatic relief while PND recurred twice in one patient. Pre-operative workup and imaging may not be suspicious in patients with single-duct PND and underlying malignancy, therefore, microdochectomy should be considered in such cases.