Nipple Discharge

What is Nipple Discharge?

Nipple discharge is defined as any fluid or liquid that comes out of the nipple of the breast either spontaneously or on squeezing of the breasts or nipples. It is a normal function of the breast that occurs during pregnancy and breast-feeding. However, nipple discharge can also occur as a result of an abnormality in the breast and is the third most common reason women visit a doctor for their breast-related conditions after breast pain and lump. The nipple discharge may be milky, clear, bloody, yellow, or brown in appearance and may vary in consistency from thin and watery to thick and sticky.

What Causes Abnormal Nipple Discharge?

Abnormal nipple discharge is referred to as any discharge that is spontaneous, blood-stained, persistent, and unrelated to breastfeeding or pregnancy. Some of the causes of abnormal nipple discharge include:

  • Mammary duct ectasia – widening and thickening of the milk ducts under the nipple
  • Excessive stimulation of the nipples
  • Breast cancer
  • Intraductal papilloma – a benign wart-like growth in a milk duct in the breast
  • Breast infection
  • Hormonal disorders
  • Trauma or injury to the breasts
  • Medication and drugs
  • Side effects of oral contraceptive pills
  • Fibrocystic breasts - a condition that gives a lumpy or rope-like texture to breasts
  • Periductal mastitis – a condition of inflamed and infected nipples

When Should You See a Doctor for Nipple Discharge?

You need to seek immediate medical attention from your doctor for nipple discharge if it is accompanied with any of these:

  • Pain, redness, swelling, or lump in the breasts
  • Foul-smelling or blood-stained discharge
  • Changes in nipple such as inward turning, dimpling, scaling, itching, or change in colour
  • Change in size, shape, and consistency of breast
  • A discharge that comes from only one breast
  • A discharge that seeps out without any pressure on your breasts
  • You are no longer breast feeding but yet notice discharge
  • The discharge is not a one-off episode and is regularly occurring
  • You are over the age of 50

How is Nipple Discharge Diagnosed?

Some of the tests and procedures involved with the diagnosis of nipple discharge include:

  • A review of your medical history to check for any previous history of breast conditions
  • A clinical breast examination to check for any lumps, nipple abnormalities, tenderness, or changes in the appearance of the breasts
  • Mammogram – an X-ray examination of the breast to check for subtle changes not detected during physical exam
  • Ultrasound scan – use of high-frequency sound waves to create pictures of breast tissue to differentiate between a fluid-filled cyst and a solid mass
  • Magnetic resonance imaging (MRI) – use of radio wave and strong magnetic field to produce detailed images of breast tissue to detect cancerous lesions
  • Breast biopsy – surgical removal of a sample of breast tissue or cells and fluid from a suspicious area for microscopic analysis
  • Blood tests to look for hormonal abnormalities

What is the Treatment Involved with Nipple Discharge?

Once the cause of your nipple discharge is diagnosed, your doctor may recommend ways to treat it, including:

  • Observation and conservative management
  • Selective Microdochectomy to remove only the discharging duct 
  • Total duct excision or surgical removal of all central ducts

Surgery for significant abnormality, such as breast cancer