Nipple Discharge

About Nipple Discharge

Many women will have spontaneous nipple discharge. It is one of the most common breast problems for which women seek medical attention. Although the majority of cases are associated with non-malignant changes in the breast, all nipple discharge should be evaluated by a physician to make sure there is no underlying disease.

What causes nipple discharge?

Physiologic or natural discharge, the most common type of nipple discharge, is usually caused by lactation, breast manipulation or excessive movement during exercise or activity. It is normally clear or milky and occurs in both breasts. Medication and herbal-induced discharge is stimulated by the increased level of prolactin caused by certain prescription drugs and over-the-counter medications and herbal products. Disease-induced discharges account for most bloody or watery nipple discharges. Ninety percent of these are due to benign conditions, such as:

• Papillomas—non-cancerous tumors that have grown inside the breast duct
• Fibrocystic conditions
• Mammary duct ectasia—dilation of the duct with fluid accumulation 

Only ten percent of suspicious nipple discharge is caused by a malignant (cancerous) lesion.

When is nipple discharge a concern?

Evaluation should be pursued if discharge is:

• Bloody or watery with a red, pink, or brown to black color
• Sticky to the touch
• Spontaneous
• Unilateral (on one side) or from a single duct
• Persistent.

Does nipple discharge usually occur with breast cancer?

• Cancers in the breast or at the nipple can cause nipple discharge. However, less than three percent of patients with breast cancer will have nipple discharge.

Can men have nipple discharge?

• During puberty both males and females can experience a milky nipple discharge. However, when nipple discharge occurs in adult males, mammography should be performed. There is a higher incidence of malignancy associated with nipple discharge in adult males than in females.

Can pregnancy cause bloody discharge?

• Rapid growth of breast tissue during pregnancy and lactation can cause duct irritation, sometimes resulting in bloody discharge. Although this is usually not reason for concern, it should be reported to your physician and a clinical exam of the breasts should be performed. Further evaluation should be pursued if the discharge continues after lactation has stopped.

How is nipple discharge evaluated?

• A breast examination and assessment of the characteristics of the discharge by a physician
• A mammogram, if discharge is suspicious
• A mammogram, ultrasound, and possibly biopsy if a mass is present

How is nipple discharge treated?

Treatment will depend upon the diagnosis:

• If a normal nipple discharge is determined to be physiologic or medication induced, treatment can usually be limited to patient management or hormone therapy. 
• Mammary duct ectasia is a benign (non-cancerous) condition. Generally it requires only treatment of the symptoms. 
• Intraductal papilloma is the most common benign breast disease causing discharge. Although it is not a cancer, it does require surgical excision of the involved duct. Usually the rest of the breast remains intact. 
• Malignant diseases/breast cancers do require surgical treatment. The extent of surgery depends upon the involvement of the cancer.

How is surgical excision of a duct performed?

• Duct excision is usually done through a small circular incision near the areolar border around the nipple. The incision is closed with absorbable sutures underneath the skin. The procedure is usually done on an outpatient basis in the operating room under general anesthesia.