Nipple discharge

Overview

• 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

• 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

• Dependent on the cause; benign causes may not require treatment.
• Surgery: For intraductal papillomas 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.