Nipple discharge

Nipple discharge
Light white nipple discharge
Specialty Urology Edit this on Wikidata

Nipple discharge is the release of fluid from the nipples of the breasts. Abnormal nipple discharge may be described as any discharge not associated with lactation.[1] The nature of the discharge may range in color, consistency and composition, and occur in one or both breasts. Although it is considered normal in a wide variety of circumstances it is the third major reason involving the breasts for which women seek medical attention, after breast lumps and breast pain. It is also known to occur in adolescent boys and girls going through puberty.

Presentation

Nipple discharge refers to any fluid that seeps out of the nipple of the breast. Discharge from the nipple does not occur in lactating women. And discharge in non-pregnant women or women who are not breasfeeding may not cause concern. Men that have discharge from their nipples are not typical. Discharge from the nipples of men or boys may indicate a problem. Discharge from the nipples can appear without squeezing or may only be noticeable if the nipples are squeezed. One nipple can have discharge while the other does not. The discharge can be clear, green, bloody, brown or straw-colored. The consistenct can be thick, thin, sticky or watery.[2][3]

Complications

Nipple discharge may be a symptom of breast cancer or a pituitary tumor. Skin changes around the nipple may be caused by Paget disease.[2]

Causes

Some cases of nipple discharge will clear on their own without treatment. Nipple discharge is most often not cancer (benign), but rarely, it can be a sign of breast cancer. It is important to find out what is causing it and to get treatment. Here are some reasons for nipple discharge:[2]

  • Pregnancy
  • Recent breastfeeding
  • Rubbing on the area from a bra or t-shirt
  • Trauma[4]
  • Infection
  • Inflammation and clogging of the breast ducts
  • Noncancerous pituitary tumors
  • Small growth in the breast that is usually not cancer
  • Severe underactive thyroid gland (hypothyroidism)
  • Fibrocystic breast (normal lumpiness in the breast)
  • Use of certain medicines
  • Use of certain herbs, such as anise and fennel
  • Widening of the milk ducts[2]
  • Intraductal pipilloma
  • Subareolar abscess[1]
  • Mammary duct ectasia[5]
  • Pituitary tumor[4]

Sometimes, babies can have nipple discharge. This is caused by hormones from the mother before birth. It usually goes away in 2 weeks. Cancers such as Paget disease (a rare type of cancer involving the skin of the nipple) can also cause nipple discharge.[2]

Nipple discharge that is NOT normal is bloody, comes from only one nipple, or comes out on its own without squeezing or touching the nipple. Nipple discharge is more likely to be normal if it comes out of both nipples or happens when the nipple is squeezed. Squeezing the nipple to check for discharge can make it worse. Leaving the nipple alone may make the discharge stop.[2]

Diagnosis

The diagnosis of nipple discharge will be determined upon an examination by a health provider who will ask questions about symptoms and medical history. Tests that may be done include:

  • Prolactin blood test
  • Thyroid blood tests
  • Head CT scan or MRI to look for pituitary tumor
  • Mammography
  • Ultrasound of the breast
  • Breast biopsy
  • Ductography or ductogram: an x-ray with contrast dye injected into the affected milk duct
  • Skin biopsy, if Paget disease is a concern[2]

Treatment

Initially, an evaluation of malignancy is always indicated. If no abnormality is found, then a surgical duct excision may resolve the symptoms. Treatment also depends on whether single-duct or multiple-duct discharge is present, and whether the symptoms of nipple discharge are distressing to the patient. In some cases, there may be no need for any further intervention; in others, microdochectomy or a total duct excision may be appropriate. If the patient wishes to conserve the ability to breastfeed and only single-duct discharge is present, then ductoscopy or galactography should be considered in view of performing a localised duct excision.[6] Once the cause of the nipple discharge is found, it will be treated by the health provider who will evaluate:

  • Whether changing any medicine that has caused the discharge is appropriate
  • Whether any lumps should be removed
  • Whether some or all of the breast ducts should be removed
  • If a prescription for cream to treat skin changes around the nipple will be helpful
  • If medicines to treat a health condition are required[2]

If all the tests are normal, treatment may not be necessary. A follow up mamogram mammogram and physical exam may be prescribed within 1 year.[2]

Prognosis

Most of the time, nipple problems are not breast cancer. These problems will either go away with the right treatment, or they can be watched closely over time.

See also

References

  1. 1 2 "Abnormal discharge from the nipple: MedlinePlus Medical Encyclopedia Image". medlineplus.gov. Retrieved 12 August 2017. This article incorporates text from this source, which is in the public domain.
  2. 1 2 3 4 5 6 7 8 9 "Nipple discharge: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 12 August 2017. This article incorporates text from this source, which is in the public domain.
  3. ↑ "Nipple discharge". Retrieved 12 August 2017.
  4. 1 2 Cash.
  5. ↑ Schnitt.
  6. ↑ J Michael Dixon (22 June 2013). Breast Surgery: Companion to Specialist Surgical Practice. Elsevier Health Sciences. p. 274. ISBN 978-0-7020-4967-5.

Bibliography

  • Schnitt, Stuart (2013). Biopsy interpretation of the breast. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9781451113013. electronic book, no page numbers
  • Cash, Jill (2014). Family practice guidelines. New York: Springer Publishing. ISBN 9780826197825. electronic book, no page numbers
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