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Nipple discharge
Definition
Clinically significant nipple discharge is the spontaneous,
persistent, and nonlactational secretion of fluid (discharge) from the
nipple.
Non–clinically significant nipple discharge more commonly occurs in
women using contraceptives. Non–clinically significant nipple
discharge also occurs in women who are taking medications that have
estrogen-like effects on the breast epithelium.
Character of nipple discharge
- Milky: galactorrhea
- Purulent (pus): infection
- Multicolored or sticky discharge: duct ectasia
Duct ectasia (comedomastitis) appears as burning, itching, and pain
associated with palpable subareolar, tortuous, tubular swellings.
- Serous discharge: intraductal papilloma (usually characterized by
nipple discharge without a mass), cysts, or cancer; surgical
exploration is imperative.
- Serosanguineous discharge: intraductal papilloma (usually
characterized by nipple discharge without a mass), cysts, or cancer;
surgical exploration is imperative.
- Bloody discharge: intraductal papilloma (usually characterized by
nipple discharge without a mass), cysts, or cancer; surgical
exploration is imperative.
- Watery discharge: intraductal papilloma (usually characterized by
nipple discharge without a mass), cysts, or cancer; surgical
exploration is imperative. Watery discharge is very suggestive of
cancer.
- A green discharge from one breast and especially from one
duct is most likely fibrocystic change in the breast.
Bilaterality of nipple discharge
The presence of discharge in one or both breasts could be
suggestive of the following diseases although not conclusive.
Unilateral nipple discharge: cancer, infection, cysts,
benign growth (papilloma), duct ectasia.
Bilateral nipple discharge: galactorrhea, contraception or
estrogen administration
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