Nipple discharge

Nipple discharge
Milk coming from the nipple
SpecialtyGynecology
TypesPhysiologic, pathologic[1]
Diagnostic methodNormal: Late pregnancy, after childbirth, newborns[2][3]
Abnormal: Intraductal papilloma, duct ectasia, blocked milk duct, infected breast, breast cancer, high prolactin[1][4][3]
TreatmentDepends on the cause[2]
FrequencyCommon[2]

Nipple discharge is fluid from the nipple, with or without squeezing the breast.[2][5] The discharge can be milky, clear, green, purulent, bloody, or faintly yellow.[6] The consistency can be thick, thin, sticky, or watery.[5][6]

Nipple discharge may be normal, such as milk in late pregnancy or after childbirth, and in newborns during the first weeks of life.[2][3] It may also be normal following squeezing, in women during the reproductive years.[2][5] It is likely abnormal if it occurs in men, contains blood, is from only one breast, or is associated with a breast lump, swelling, redness or overlying skin changes.[2][3] Reasons for abnormal discharge include an intraductal papilloma, duct ectasia, blocked milk duct, infected breast (mastitis or breast abscess), breast cancer, certain medications, and conditions that raise prolactin.[1][3][4]

Milky discharge in a non-pregnant, non-breast feeding women is evaluated differently to other abnormal nipple discharge.[4] Often, the cause can be determined based on symptoms and examination.[5] Blood tests may be done to rule out low thyroid or high prolactin.[7] Other tests may include mammography, breast ultrasound, breast biopsy, or skin biopsy.[8]

Treatment depends on the underlying cause.[2] Duct ectasia may be treated with surgical removal of the ducts involved.[2] Infectious causes may require antibiotics or incision and drainage.[2] Nipple discharge is the third most common breast complaint by women, after breast pain and a breast lump.[4] About 3% of breast cancer cases are associated with discharge.[4][9]

  1. ^ a b c Salzman, B; Fleegle, S; Tully, AS (15 August 2012). "Common breast problems". American Family Physician. 86 (4): 343–9. PMID 22963023.
  2. ^ a b c d e f g h i j Saj2020, Karima R.; Sugumar, Kavin; Adigun, Rotimi (2020), "Breast Nipple Discharge", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 28613688, retrieved 2 November 2020{{citation}}: CS1 maint: numeric names: authors list (link)
  3. ^ a b c d e "Nipple discharge". nhs.uk. 19 October 2017. Archived from the original on 30 October 2020. Retrieved 30 October 2020.
  4. ^ a b c d e Danielle Mazza (2011). "11. Nipple discharge". Women's Health in General Practice. Churchill Livingstone Elsevier. p. 189. ISBN 9780729538718.
  5. ^ a b c d Brennan, Meagan; Houssami, Nehmat; French, James (May 2005). "Management of benign breast conditions. Part 3 – other breast problems" (PDF). Australian Family Physician. 34 (5): 353–355. PMID 15887938.
  6. ^ a b Barry, Michele (1990), Walker, H. Kenneth; Hall, W. Dallas; Hurst, J. Willis (eds.), "Nipple Discharge", Clinical Methods: The History, Physical, and Laboratory Examinations (3rd ed.), Boston: Butterworths, ISBN 978-0-409-90077-4, PMID 21250127, retrieved 2020-10-30
  7. ^ Arthur, Rhonda (2014). "13. Gynaecologic guidelines". In Jill C., Cash; Glass, Cheryl A. (eds.). Family Practice Guidelines, Third Edition. Springer Publishing Company. p. 450. ISBN 978-0-8261-9782-5.
  8. ^ Cite error: The named reference DeMuro2018 was invoked but never defined (see the help page).
  9. ^ Saad, Reda S.; Silverman, Jan F. (2008). "25. Breast". In Marluce Bibbo (ed.). Comprehensive Cytopathology. David Wilbur (Third ed.). Saunders Elsevier. pp. 760–761. ISBN 978-1-4160-4208-2.