By VANESSA PROWLER, MD
Nipple discharge, one of the most common breast complaints in women, is defined by fluid that leaks out of the nipple of the breast.
Up to 50%-80% of women experience small quantities (drops) of nipple discharge at some point during their reproductive years. Nipple discharge normally occurs during pregnancy and while breastfeeding due to hormonal changes.
Nipple discharge in non-pregnant women is often benign and can be caused by a multitude of factors, but should be evaluated. Nipple discharge in a man, however, is never normal and requires additional evaluation.
There are three types of nipple discharge: lactation, physiologic and pathologic (suspicious) discharge.
Lactation is normal milk production by the mammary glands that occurs during pregnancy and after giving birth. This can last more than 6 months after delivery or after you have stopped breastfeeding.
In two-thirds of women who are not breastfeeding, nipple discharge can occur when the breast is cleaned (in the shower), massaged or pressure is applied. This discharge is not spontaneous since something is touching the nipple or breast to stimulate it to secrete fluid. This is considered physiologic, or normal, discharge, and can range in color from white to yellow, green to blue, brown or black. This occurs because the breast is a type of apocrine or sweat gland, which is also found in the skin, eyelid and ear. Many things can cause physiologic nipple discharge, including medications, breast stimulation from manipulation or clothing (such as a poorly fitting bra), hyperprolactinemia, pituitary gland tumors in the brain, hypothyroidism, trauma, and breast infections. If the discharge is not due to an underlying problem in the brain, medication or abnormal hormone level, it usually stops when you stop manipulating the breast and requires no specific treatment.
Spontaneous discharge is just like it sounds and occurs without any manipulation to the nipple or breast. Spontaneous nipple discharge is often pathologic. Pathologic discharge usually only occurs on one side (one breast) and can be clear, yellow or bloody. The most common cause (more than 50% of the time) is a papilloma, a benign tumor within a duct of the breast. Some papillomas can contain atypical cells or cancer. Ductal ectasia, which is a widening and thickening of the walls of the duct, can lead to a blockage and build-up of fluid. Cancer is identified in up to 15% of women with pathologic nipple discharge. When your discharge is pathologic, your physician will order imaging to look for a source. This imaging may include a mammogram, breast ultrasound and/or breast MRI. If a lesion is identified, you will need a biopsy to sample the tissue it contains and may be referred to a surgeon to discuss surgical excision of the offending area.
Ductogram or galactograms involve filling the offending duct with dye then having a mammogram. These are painful, low yield, and no longer recommended by Breast Surgeons or our national societies.
If you are experiencing nipple discharge, talk to your doctor. He or she may refer you to a Breast Surgeon for further evaluation.
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