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Nipple Discharge

By

Mary Ann Kosir

, MD, Wayne State University School of Medicine

Last full review/revision Sep 2020| Content last modified Sep 2020
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Fluid that leaks from one or both nipples is called a nipple discharge. Each breast has several (15 to 20) milk ducts. A discharge can come from one or more of these ducts.

Nipple discharge can occur normally during the last weeks of pregnancy and after childbirth when breast milk is produced. A nipple discharge can also be normal in women who are not pregnant or breastfeeding, especially during the reproductive years. For example, in women, fondling, suckling, irritation from clothing, or sexual arousal can stimulate a nipple discharge, as can stress. However, a nipple discharge in men is always abnormal.

A normal nipple discharge is usually a thin, cloudy, whitish, or almost clear fluid that is not sticky. However, the discharge may be other colors, such as gray, green, yellow, or brown. During pregnancy or breastfeeding, a normal discharge is sometimes slightly bloody.

Abnormal discharges vary in appearance depending on the cause. An abnormal discharge may be accompanied by other abnormalities, such as dimpled skin, swelling, redness, crusting, sores, and an inverted (retracted) nipple. (A nipple is inverted if it pulls inward and does not return to its normal position when it is stimulated.) If a discharge from only one breast occurs on its own (without any stimulation of the nipple), it is considered abnormal.

Causes of Nipple Discharge

Several disorders can cause an abnormal discharge.

A discharge from both breasts or from several milk ducts in one breast is more likely to be caused by a problem outside the breast, such as a hormonal disorder or use of certain drugs.

Common causes of a nipple discharge

Usually, the cause is a benign disorder of the milk ducts, such as the following:

Intraductal papilloma is the most common cause. It is also the most common cause of a bloody nipple discharge when there is no lump in the breast.

Less common causes of a nipple discharge

Certain disorders stimulate the production of breast milk in women who are not pregnant or breastfeeding (see table Some Causes and Features of Nipple Discharge Some Causes and Features of Nipple Discharge Fluid that leaks from one or both nipples is called a nipple discharge. Each breast has several (15 to 20) milk ducts. A discharge can come from one or more of these ducts. (See also Overview... read more ). In most of these disorders, the level of prolactin (a hormone that stimulates production of breast milk) is elevated. Taking certain drugs can have the same effect.

Cancer causes fewer than 10% of cases.

Evaluation of Nipple Discharge

Warning signs

Nipple discharge is a cause for concern when it

  • Occurs without the nipple's being squeezed or stimulated by other means (when it occurs spontaneously)

  • Occurs in women aged 40 or older

  • Comes from only one breast

  • Is bloody or pink

  • Is accompanied by a lump that can be felt

  • Occurs in a boy or man

When to see a doctor

If a nipple discharge continues for more than one menstrual cycle or if any of the warning signs are present, women (or men) should see a doctor. Delay of a week or so is not harmful unless there are signs of infection such as redness, swelling, and/or a discharge of pus. Women with such symptoms should see a doctor within 1 or 2 days.

What the doctor does

Doctors first ask questions about the woman's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the discharge and the tests that may need to be done (see Table below).

To help identify the cause, doctors ask about the discharge and about other symptoms that may suggest possible causes. They ask

Women are also asked whether they have had disorders or take drugs that can increase prolactin levels.

Doctors examine the breast, looking for abnormalities, including lumps Warning signs A breast lump (mass) is a thickening or bump that feels different from surrounding breast tissue. A lump may be discovered in a breast incidentally, during a breast self-examination, or during... read more . If the discharge does not occur spontaneously, the area around the nipples is gently pressed to try to stimulate a discharge.

Doctors also feel the lymph nodes in the armpits and above the collarbone to check for enlarged lymph nodes.

Table
icon

Testing

If doctors suspect that a hormonal disorder is the cause, blood tests are done to measure the levels of prolactin and thyroid-stimulating hormone.

If a pituitary or brain disorder is suspected, magnetic resonance imaging (MRI) or computed tomography (CT) of the head is done.

If the discharge is not obviously bloody, it is analyzed to determine whether it contains small amounts of blood. If blood is present, a sample of the discharge is examined under a microscope (called cytology) to look for cancer cells.

If a lump can be felt, ultrasonography is done. Testing Testing A breast lump (mass) is a thickening or bump that feels different from surrounding breast tissue. A lump may be discovered in a breast incidentally, during a breast self-examination, or during... read more is similar to that for any breast lump. Cysts are drained (by aspiration), and the fluid is tested. If cysts remain after aspiration or if lumps are solid, mammography is done, followed by a biopsy.

When there is no lump but cancer is still suspected or when other test results are unclear, mammography is done.

If ultrasonography and mammography do not identify a cause and the discharge occurs spontaneously and comes from one milk duct, doctors usually do a special type of mammogram (called a ductogram, or galactogram). For this procedure, a contrast agent (which helps make images clearer) is injected into the duct, and images are taken, just as for a regular mammogram. This test can help rule out or identify cancer.

If no lump can be felt and the mammogram is normal, cancer is highly unlikely.

Sometimes a specific cause cannot be identified.

Treatment of Nipple Discharge

If a disorder is identified, it is treated.

If a noncancerous tumor or disorder is causing a discharge from one breast, the duct that the discharge is coming from may be removed. This procedure requires only a local anesthetic and does not require an overnight stay in the hospital.

Key Points about Nipple Discharge

  • Usually, the cause of nipple discharge is not cancer.

  • If the discharge comes from both breasts or from several milk ducts and is not bloody or pink, the cause is usually a noncancerous hormonal disorder.

  • If the discharge comes from only one breast and is bloody or pink, cancer is possible, especially in women aged 40 or older.

  • Whether blood tests, imaging (such as ultrasonography), or both is done depends on the suspected cause.

Drugs Mentioned In This Article

Generic Name Select Brand Names
COMPRO
REGLAN
No brand name
TAGAMET
ZANTAC
No US brand name
CALAN
TENORMIN
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A breast lump (mass) is a thickening or bump that feels different from surrounding breast tissue. Which of the following statements about breast lumps is NOT correct?
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