Nipple Discharge

Surgery > Breast

Background Knowledge 🧠

Definition

The release of fluid from the nipple, outside of breastfeeding.
Can be physiological or pathological in nature.

Types of Discharge

Colour: Clear, milky, green, yellow, blood-stained, or pus-like.
Consistency: Thick, sticky, thin, or watery.
Origin: Single duct or multiple ducts.

Common Causes

Physiological: Pregnancy, lactation, nipple stimulation.
Infections & Inflammations: Mastitis, breast abscess.
Ductal ectasia: Blockage of milk ducts leading to inflammation and possible abscess formation.
Intraductal papilloma: Benign tumour of the milk ducts causing blood-stained discharge.
Galactorrhoea: Milky discharge due to high prolactin levels.
Breast cancer: Especially if associated with a lump and blood-stained discharge.

Investigations 🧪

Investigations

Clinical examination: To assess the discharge and any associated lumps.
Mammography: Especially in women > 40 years or with suspicious symptoms.
Ultrasound: Especially useful in younger women.
Ductography: Injection of contrast into the nipple duct to identify the cause of discharge.
Cytology: Examination of discharge under the microscope.
Blood tests: Checking prolactin levels if galactorrhoea is suspected.

Management 🥼

Management

Dependent on the cause; benign causes may not require treatment.
Surgery: For intraductal papilloma or ductal ectasia.
Medications to reduce prolactin levels in cases of galactorrhoea.
Antibiotics for infections.

Key Points

Blood-stained nipple discharge needs urgent investigation to rule out malignancy.
Discharge from multiple ducts is usually benign, whereas single duct discharge can be more concerning.
Physiological and benign causes are more common than malignant causes of nipple discharge.

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