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Nipple discharge can be serous, mucinous, milky, bloody, or purulent. It is not necessarily abnormal, even among postmenopausal women. Cancer (usually intraductal carcinoma or invasive ductal carcinoma) is the cause in < 10% of cases. The rest result from endocrine disorders or benign ductal disorders (eg, ductal ectasia, fibrocystic changes, intraductal papilloma).
Endocrine causes involve elevated prolactin levels, which lead to galactorrhea (breast milk secretion not temporally associated with childbirth—see Pituitary Disorders: Galactorrhea). Causes include pituitary tumors, hypothyroidism, chronic renal failure, and some drugs (see Table 3: Pituitary Disorders: Causes of Hyperprolactinemia ).
Evaluation
and Treatment
A general examination is done; breast examination focuses on whether a lump or inflammation is present and which ducts (one, multiple, or bilateral) are involved. Although appearance is not diagnostic, bloody (and perhaps guaiac-positive) discharge suggests breast cancer; bilateral milky discharge from multiple ducts suggests galactorrhea.
Mammography is done. If a lump is palpable or apparent on mammogram, evaluation proceeds as for breast lumps (see Breast Disorders: Evaluation and Treatment). If no lump is palpable and mammogram is normal, cancer is highly unlikely. If the discharge is milky, endocrine evaluation is indicated. If discharge from a single duct is persistent and the cause remains unclear, diagnosis may require ductography with or without ductoscopy. Any identified lesions are excised.
Endocrine causes are treated medically. If the discharge is persistent and annoying and the cause is benign, a nipple-flap duct resection, usually done as an outpatient procedure using a local anesthetic, can eliminate the discharge and relieve the patient's anxiety.
Last full review/revision November 2005
Content last modified November 2005
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