This symptom involves abnormal discharge from the nipple(s)
The nature of the discharge can range in colour, consistency, composition, and may occur on one or both breasts may produce a nipple discharge, either spontaneously or when you squeeze your nipples or breasts. A nipple discharge may look milky, or it may be clear, yellow, green, brown or bloody. The consistency of nipple discharge can vary - it may be thick and sticky or thin and watery.
Nipple discharge is a normal part of breast function during pregnancy or breast-feeding. It also may be associated with menstrual hormone changes and fibrocystic changes. The milky discharge after breast-feeding will normally affect both breasts and can continue for up to two or three years after stopping nursing.
A papilloma is a noncancerous (benign) tumor that can be associated with bloody discharge. It appears spontaneously and involves a single duct. Although the bloody discharge may resolve on its own, this situation requires evaluation with an ultrasound of the area behind the nipple and areola. If the ultrasound shows a lesion within a milk duct, you may need a biopsy to confirm that it's a papilloma or to exclude a cancer.
Often, nipple discharge stems from a benign condition. However, breast cancer is a possibility, especially if:
- You have a lump in your breast
- Only one breast is affected
- The discharge contains blood or is clear
- The discharge is spontaneous and persistent
- The discharge affects only a single duct
Are you pregnant?
- Are you breastfeeding?
- What type of drainage is there?
- Does it look like milk (even though you are not breastfeeding)?
- Does it look bloody?
- Does it look like pus?
- Is the drainage from both breasts?
- How much drainage is there?
- Enough to stain the lining of the bra?
- Enough to soak through the bra?
- Does the discharge occur spontaneously, or only when expressed?
- Do you perform breast self-examination? How often?
- What medications do you take?
- Are there any other symptoms present such as:
- a breast lump
- breast pain
- headaches or change in vision
The physical examination will include examination of the breasts for lumps or other abnormalities.
Possible causes of nipple discharge include:
- Birth control pills
- Breast cancer
- Ductal carcinoma in situ (DCIS)
- Endocrine disorders
- Excessive breast stimulation
- Fibrocystic breasts (lumpy or rope-like breast tissue)
- Injury or trauma to the breast
- Intraductal papilloma (a benign, wartlike growth in a milk duct)
- Mammary duct ectasia
- Mastitis (an infection in breast tissue that most commonly affects women who are breast-feeding)
- Medication use
- Menstrual cycle hormone changes
- Paget's disease of the breast
- Periductal mastitis
Diagnostic tests that may be performed include:
- Breast biopsy (if lump is found)
- Head CT scan to look for pituitary tumour
- Serum prolactin
- Ultrasonography (ultrasound of the breast)