Some Causes and Features of Nipple Discharge
Cause |
Common Features* |
Tests |
Benign breast disorders |
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Intraductal papilloma (a benign tumor in a milk duct)—the most common cause |
A bloody or pink discharge from one breast |
Usually ultrasonography Additional tests depending on the results (evaluation as for breast lumps) |
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Mammary duct ectasia (dilated milk ducts) |
A bloody, pink, or multicolored (puslike, gray, or milky) discharge from one or both breasts |
Same as for intraductal papilloma |
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Fibrocystic changes (including pain, cysts, and general lumpiness) |
A lump, often rubbery and tender, usually developing before menopause Possibly a pale yellow, green, or white discharge Possibly a history of having breast lumps |
Same as for intraductal papilloma |
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Pain, tenderness, redness, warmth, or a combination that begins suddenly in a breast Often fever With an abscess, a tender lump and possibly a puslike discharge that smells foul |
Physical examination (infection is usually obvious) If the discharge does not resolve with treatment, evaluation as for intraductal papilloma |
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Usually intraductal carcinoma or invasive ductal carcinoma |
Possibly a palpable lump, changes in the skin, or enlarged lymph nodes, most often in the armpit Sometimes a bloody or pink discharge |
Same as for intraductal papilloma |
Increased levels of prolactin† |
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Various disorders, including the following: |
A milky (not bloody) discharge, usually from both breasts No lumps Possibly menstrual irregularities or no menstrual periods (amenorrhea) |
Blood tests to measure prolactin and thyroid-stimulating hormone levels A review of drugs being taken If the prolactin or thyroid-stimulating level is elevated, MRI of the head |
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Intolerance of cold, sluggishness, constipation, or weight gain |
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Possibly hormonal abnormalities (such as absence of menstrual periods or infertility), changes in vision, or headaches |
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With liver disorders, ascites or jaundice In people known to have a kidney or liver disorder |
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Certain drugs including
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Blood tests to measure prolactin and thyroid-stimulating hormone levels A review of drugs being taken If the prolactin or thyroid-stimulating level is elevated, MRI of the head |
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* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. |
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† Prolactin is a hormone that stimulates production of breast milk. |
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‡ Ranitidine (taken by mouth, intravenously, and over the counter) has been removed from the market in the United States and in many other countries because of unacceptable levels of N-nitrosodimethylamine (NDMA), which is a substance that probably causes cancer. |
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MRI = magnetic resonance imaging. |
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