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Nipple discharge in women: Secretions often more alarming than dangerous
From MayoClinic.com
Special to CNN.com

Most women who've breast-fed have experienced unwelcome moments of nipple discharge. But having a discharge unrelated to breast-feeding is understandably concerning.

Because your breast is a gland, secretions from your nipples aren't unusual, even for women who've never been pregnant.

Fortunately, nipple discharge usually isn't associated with cancer (malignancy). Several conditions could be responsible for the secretions. In some cases, nipple discharge does require treatment and may not go away on its own. Discover what might cause nipple discharge, and how your doctor will find and treat the underlying cause.

What is nipple discharge?

Any fluids that seep out of your nipple are referred to as nipple discharge. Your nipples have many tiny openings through which fluid can pass. In the case of the nursing mother, this fluid is breast milk. In other cases, it may look like milk but it really isn't. The fluid can differ with regard to color — from milky white to yellow, green, brown or bloody — and consistency — from thin and watery to thick and sticky.

Nipple discharge can happen in one or both nipples. It can be spontaneous — happening on its own at any time — or happen only when you squeeze your nipple or manipulate your breast in some way. Your chances of having unusual nipple discharge increase as you get older and with the number of pregnancies you've had.

If you have unusual nipple discharge, make an appointment with your doctor to have it evaluated. A visit to your doctor is especially important if you also notice breast changes, such as a new lump or skin changes. This will help your doctor identify the root of the problem.

Make an appointment with your doctor

Your doctor will likely ask you some questions to gain a better understanding of what's going on. Specifically, he or she may want to know:

  • What color is the discharge?
  • How much discharge is there?
  • Does it happen in one or both breasts?
  • Does the discharge appear to come from one opening in your nipple or multiple openings?
  • Is the discharge spontaneous, or does it happen only when you squeeze your nipple?
  • Do you have any other signs and symptoms, such as fever, redness, pain in the breast, headaches or vision changes?
  • Have you recently experienced an injury to the chest?
  • What medications do you take?

Be prepared to answer these types of questions and bring up any other observations you think may be relevant. For instance, your doctor might want to know how long you've experienced the nipple discharge and certain facts about your medical history.

Based on the information you provide and the results of a physical exam, you might need to undergo additional testing to help pinpoint the underlying cause. Such testing might include a blood test, mammography, a breast ultrasound, a special type of X-ray (ductogram) or magnetic resonance imaging (MRI). Your doctor might collect a sample of the fluid to send to a lab for analysis. However, even after lab analysis, further evaluation may be necessary.

Determine possible causes

Your nipple discharge might just be a normal (physiological) part of your breast's function. That is, it might not be caused by any underlying disease. On the other hand, if your doctor determines that your nipple changes aren't normal breast gland secretions, other causes may be considered.

Among the many possible causes of nipple discharge are:

Normal functioning (physiological discharge)
Physiological nipple discharge usually occurs in both breasts and happens only when the breast tissue is manipulated in some way, such as by squeezing the nipple to check for discharge. The discharge may be clear, yellow, white or dark green. Stimulation of the nipple actually increases the likelihood of discharge, so it's best to leave your nipples alone and avoid checking them. This type of discharge often resolves on its own.

An inflamed duct (mammary duct ectasia)
Mammary duct ectasia is one of the most common conditions related to abnormal nipple discharge. It causes one or more of the ducts beneath your nipple to become inflamed and clogged with a thick, sticky substance that's green or black. Most often, it affects women in their 40s and 50s. You can relieve some of your symptoms by applying warm compresses to your breast. Taking aspirin or nonsteroidal anti-inflammatory drugs, such as ibuprofen, may help relieve some symptoms. Also, your doctor may prescribe antibiotics to clear up any infection. In some cases, surgery might be necessary to remove the affected duct.

The classic symptom of an intraductal papilloma is bloody discharge from one nipple.

A small, noncancerous growth in a duct (intraductal papilloma)
Intraductal papilloma is a small, usually noncancerous (benign) growth that projects into a milk duct near your nipple. It occurs most often in women between the ages of 35 and 55. Nobody knows what causes intraductal papillomas, and there are no known risk factors.

The discharge may be bloody or sticky and usually occurs spontaneously from one duct only, with manipulation of your nipple. You may notice staining or spotting from the discharge on your shirt or the inside of your bra. You may also feel a small lump behind and near the edge of your nipple (areola).

Your doctor may perform an ultrasound on your areola and surrounding area to check for a nodule in a duct. Treatment involves surgical removal of the involved duct and examination of the tissue to rule out cancer.

Milk production even though you're not pregnant or nursing (galactorrhea)
The nipple discharge associated with galactorrhea is usually white or clear, but it could be yellow or green. Fluid may leak from one or both breasts. Galactorrhea occurs because your body is making too much prolactin — the hormone your brain produces to stimulate milk production when you have a baby.

Possible causes include:

  • A hormonal imbalance, such as from taking birth control pills
  • An underactive thyroid gland
  • A tumor (prolactinoma) or other disorder of the pituitary gland
  • Chronic breast stimulation, such as from frequent breast self-exams or sexual activity

An injury
A blunt trauma — for instance, the impact of the steering wheel in a car accident or a hard blow to your chest during a sporting activity — can cause nipple discharge in both your breasts. The nipple discharge results from tissue damaged by the blow and may be clear, yellow or bloody. The discharge often occurs spontaneously and involves multiple ducts.

A breast infection (abscess)
Most common in lactating women, a breast abscess can happen when your nipples become irritated or infected from breast-feeding. A break or crack in your skin can allow bacteria to invade your breast tissue, causing an infection. The nipple discharge may contain pus, and the breast can become red, swollen and warm to the touch. Treatment involves surgically draining the abscess, and your doctor also may prescribe antibiotics.

Changes in breast tissue (fibrocystic changes)
Fibrocystic breast changes result in lumpy, tender breasts and can produce a clear, yellow or light green discharge from your nipples. Fibrocystic changes are very common, occurring to varying degrees in about half of all women. Your doctor may run some tests — such as a mammogram or an ultrasound — to make sure the discharge isn't caused by cancer. If the tests show fibrocystic changes as the underlying cause, no further treatment is necessary.

Breast cancer
Nipple discharge rarely is a sign of breast cancer, but it's possible that discharge may indicate cancer is present within a duct (intraductal breast cancer) or outside the duct (invasive breast cancer). See your doctor promptly for evaluation if your discharge is bloody, spontaneous and occurs in only one breast.

Another form of cancer — Paget's disease of the breast — also is associated with nipple discharge. Paget's disease of the breast is an uncommon cancer that occurs in only 1 percent to 4 percent of all women with breast cancer. Signs and symptoms include itching, burning, redness or scaling of the nipple and areola — the darker colored skin surrounding the nipple. You may also have a bloody discharge from the nipple, and the nipple may appear flattened against your breast. Your doctor can diagnose the disease by doing a biopsy of the affected area of the areola. Standard treatment is removal of the breast (mastectomy), but removal of just the breast tumor (lumpectomy) may sometimes be an option. Your doctor might recommend chemotherapy or radiation after surgery.

Here's an at-a-glance rundown of what might be causing your nipple discharge.

If the nipple discharge is ... It might be caused by ...
Clear, yellow, white or dark green Normal (physiological) breast function
Clear, straw-colored Early pregnancy
Thin, milky Pregnancy or breast-feeding
Bloody Intraductal papilloma
Breast cancer
Pus Breast infection
Milky or clear, possibly yellow or green Galactorrhea
Clear, yellow or bloody An injury
Yellow, green, brown or black Duct ectasia
Fibrocystic breast changes

Gain peace of mind

Take comfort in knowing that most nipple problems are the result of a benign condition. They're usually more scary than dangerous. But it's best to see your doctor anytime you notice changes in your nipples or breasts because the problem may require treatment. By determining the underlying cause, your doctor can remedy your problem. And if you learn that the nipple discharge results from a more serious condition, catching the problem early gives you the best chance for recovery.

January 28, 2005

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