Nipple Discharge

Nipple Discharge

The term “nipple discharge” refers to any fluid that leaks out of the nipple(s) of the breast. Nipple discharge is a normal part of breast function during pregnancy and breastfeeding, and can be a normal result of menstrual cycle hormone changes. Nipple discharge in a woman who is not pregnant or breastfeeding is not necessarily abnormal and can be caused by many factors but should be evaluated. Nipple discharge in a man is not normal under any circumstances and requires further evaluation.

Anatomy of the Breast

Your breast is composed of three types of tissue:

•Glandular tissue is made up of the milk ducts and glands (lobules). The lobules produce milk for breastfeeding. The milk ducts transport the milk from the lobules to the nipple.

•Fibrous tissue is the connective tissue that surrounds the lobules and ducts, and supports the breast.

•Fat fills the spaces between the other tissues. It is the amount of fat in the breast that gives the breast its size.

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Normal (Physiologic) Nipple Discharge

Nipple discharge is considered normal when it is nonspontaneous (that is, resulting from manipulation) from multiple breast ducts. The color of the discharge may be yellow, white, gray, green, blue, or even dark brown. Normal nipple discharge can occur due to pregnancy or breastfeeding, following breast stimulation with intercourse or a warm shower, and in women with thyroid conditions or hormonal imbalances or who are taking certain medications, including estrogens, oral contraceptives, opiates, some antihypertensive medications, antipsychotic medications, and some antidepressant medications.

Suspicious Nipple Discharge

Nipple discharge is considered suspicious when it is spontaneous (occurring without manipulation of the breast) and persistent, unilateral, coming from only one duct with fluid characterized as clear and colorless, bloody, or pale yellow and transparent. Causes of suspicious nipple discharge include:
  • Papilloma—A small, usually noncancerous or benign lesion that grows in a milk duct of the breast
  • Ductal ectasia—A widening and thickening of the walls of a milk duct that cause the duct to become blocked, leading to fluid build-up
  • Cancer

Evaluation and Management

In women younger than age 40, appropriate follow-up for normal nipple discharge, which is nonspontaneous and leaking from multiple ducts, includes:
  • Observation
  • Education to stop stimulation or manipulation of the breast(s)
  • Instructions to report the development of any spontaneous suspicious nipple discharge
In women 40 years and older, evaluation of nipple discharge may include:
  • Mammography
  • Education, similar to that of younger women, to stop stimulation or manipulation of the breast(s)
Additional tests are based on history and physical exam, as well as mammography findings, but may include the following:
  • Blood tests to check hormone levels (thyroid and prolactin levels)
  • Targeted breast ultrasound
  • Breast magnetic resonance imaging (MRI)
  • Mammary ductoscopy (inserting a thin tube connected to a video camera into the duct)
  • Ductogram, also known as a Galactogram (filling the problematic duct with a dye and then obtaining a mammogram)
  • Biopsy or surgery

 

Reference

NCCN Guidelines: Breast Cancer Screening and Diagnosis (Version 1.2014)

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