Nipple Discharge

Nipple conditions are a common benign breast condition affecting many women. Some problems are related to lactation, while others are not. Like all breast conditions, any nipple problems should be reported to your physician for a prompt diagnosis and treatment.

Nipple Discharge is of Concern if it is:

1. bloody or watery (serous) with a red, pink, or brown color
2. sticky and clear in color or brown to black in color (opalescent)
3. appears spontaneously without squeezing the nipple
4. persistent
5. on one side only (unilateral)
6. a fluid other than breast milk

As a woman approaches menopause (around her late 40s, early 50s), the mammary ducts, which are located under the nipple, become dilated (widened). This normal process of dilation of the milk gland is called ectasia.

Ectasia is a benign (non-cancerous) breast condition. In some cases, ectasia can lead to a blockage of the ducts. As a result, fluid may become pooled and leak into the surrounding tissue causing infection, chronic inflammation, or abscesses. If an infection, (also referred to as periductal mastitis) occurs, it may cause scar tissue to develop, thus drawing the nipple inward. In addition, this infection may cause breast pain and thick, sticky nipple discharge.

An intraductal papilloma is a small, wart-like growth that projects into the breast ducts near the nipple. This causes a bloody or sticky discharge. In addition, any slight bump or bruise near the nipple can cause the papilloma to bleed. If the discharge becomes

bothersome, the duct can be surgically removed, often without changing the appearance of the breast.

While single papillomas most often affect women nearing menopause, multiple intraductal papillomas - which often occur in both breasts - are more common in younger women. Multiple intraductal papillomas are more likely to be associated with a lump than with nipple discharge. Any papilloma associated with a lump is surgically removed.

While nipple discharge can be alarming to many women, discharge that appears only when the nipple and breast are squeezed may not be a cause for concern. The risk of cancer when nipple discharge is the only symptom is relatively low.

If there is a lump with the discharge, this will be of primary concern to your physician. Keep in mind, however, that in breastfeeding women, lactational mastitis complicated by an abscess can often cause a lump beneath the areola, as well as a discharge.

A milky discharge from both nipples, when it is not related to breastfeeding, is called galactorrhea. This is usually due to an increase in the hormone prolactin, which produces milk. Galactorrhea may be caused by tranquilizers, marijuana, or high doses of estrogen and is often accompanied by an absence of menstrual periods.

Nipple discharges which are a result of a benign breast condition may be treated by keeping the nipple clean, among other treatments. Nipple discharges which are a result of infections may require hospitalization.