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Nipple Discharge Patient education • CLINICAL PRACTICE Nipple discharge The New South Wales Breast Cancer Institute. Nipple discharge – the release of fluid from enlargement of the milk ducts under the nipple elsewhere in the body that control hormone the nipple – is very common. There are 15–20 with inflammation in the walls of the ducts. It secretion, eg. pituitary and thyroid glands. milk ducts opening onto each nipple. Discharge usually occurs in women after menopause. The Drugs and medications can come from one or more of these ducts. discharge is usually bilateral, yellow, clear, or Nipple discharge can: green in appearance and arises from multiple Some drugs can cause abnormally high • be spontaneous (fluid is secreted from the ducts. In most cases, no treatment is required prolactin levels including oral contraceptives, nipple without any squeezing of the nipple or hormone therapy, and medications used for the Duct papilloma pressure on the breast), or treatment of nausea, depression and psychiatric • be on expression (fluid is secreted from the This is a growth within a milk duct in the disorders. Drugs such as cocaine and stimulants nipple when the nipple is squeezed or there breast, usually near the nipple. It may cause can also cause high prolactin levels. is pressure on the breast) no symptoms, or a discharge that is clear or How is nipple discharge treated? • come from one breast (unilateral) or both bloodstained. Duct papillomas are almost always breasts (bilateral) benign. Very rarely, they may be associated with Physiological nipple discharge requires no • be clear, yellow, milky, brown, green, or breast cancer. Because of this rare association, treatment. It is important to stop expressing or bloodstained in appearance they are usually surgically removed. squeezing the nipple and breast as this causes • originate from one duct (one opening on the more fluid to be produced. The discharge will Nipple eczema nipple) or more than one duct. usually stop when you stop expressing. Eczema or dermatitis affecting the skin of the Spontaneous, persistent nipple discharge Physiological nipple discharge nipple can cause a weeping, crusty nipple unrelated to pregnancy or breastfeeding needs Discharge of fluid from a normal breast is discharge. Treatment is the same as for eczema investigation by examination and imaging of referred to as ‘physiological discharge’. It is elsewhere on the body. the breast with mammogram and/or breast usually yellow, milky, or green in appearance, ultrasound. Sometimes a sample of the Breast cancer does not occur spontaneously, and often discharging fluid is sent to a laboratory for originates from more than one duct. Physiological Breast cancer is an uncommon cause of nipple closer examination of the cells. nipple discharge is no cause for concern. Milky discharge. Few women with breast cancer If any abnormality is found on these tests, nipple discharge is also normal during pregnancy have nipple discharge, and most have other either fine needle or core biopsy may be and breastfeeding. symptoms, eg. a lump or newly inverted nipple. recommended. Sometimes the affected part of Breast cancer that causes nipple discharge the breast needs to be removed by a surgeon. When is nipple discharge abnormal? is likely to be benign or early invasive breast Will I need surgery? Spontaneous nipple discharge unrelated cancer rather than advanced breast cancer. to pregnancy or breastfeeding is considered Surgery for nipple discharge is usually reserved Paget disease of the nipple abnormal. In most cases it has a benign (ie. for cases where an abnormality is suspected, eg. noncancerous) cause, and is more likely to be This is a benign breast cancer involving the milk papilloma, breast cancer. Surgery may be needed unilateral, confined to one duct, and clear or ducts. It typically causes a bloodstained nipple for bloodstained nipple discharge (even if tests bloodstained in appearance. Nipple discharge discharge with ulceration and erosion of the nipple. show no abnormality) to explore the ducts under associated with other breast symptoms such the nipple for problems that didn’t show up on Hormonal causes as a lump, ulceration, or inversion of the nipple tests, or as a procedure to cure discharge caused require prompt investigation. Galactorrhoea is a milky nipple discharge by conditions such as duct ectasia. unrelated to pregnancy or lactation. It is caused Duct ectasia by the abnormal production of a hormone called Adapted from: ‘Nipple discharge’ fact sheet. The ✁ This is a benign condition in which there is prolactin which is caused by diseases of glands NSW Breast Cancer Institute www.bci.org.au Reprinted from Australian Family Physician Vol. 34, No. 5, May 2005 4 357.
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