Nipple Discharge - Causes, Diagnosis and Treatment

What Is Nipple Discharge?

When any fluid leaks out of the nipple of the breast, it is referred to as nipple discharge.

Nipple discharge during pregnancy and breastfeeding is normal. It can also occur during stimulation of the nipple, such as suckling, irritation from clothing, or sexual arousal. It is wise to consult a doctor if the nipple discharge is spontaneous. There usually are 15 to 20 milk ducts opening onto each nipple. Nipple discharge can come from one or several ducts. The consistency of nipple discharge can vary; it may be thick and sticky or thin and watery.

What Are the Causes of Normal Nipple Discharge?

Nipple discharge is considered normal. The fluid can be extracted from the nipples with the help of breast pumps and other special techniques. The fluid that can be extracted varies from 50 % to 70 % of average women. This discharge from a normal breast is referred to as physiological discharge. This discharge is milky, yellow, or green in appearance, and it does not happen spontaneously. Therefore, physiological nipple discharge is not a cause for concern.

A normal nipple discharge may be due to the following:

• Pregnancy - In the early and late stages of pregnancy, there will be watery and milky discharge from the nipple.

• Discontinuation of Breastfeeding - After nursing the baby, some women may experience milk-like breast discharge that persists for a while.

• Stimulation - During stimulation or when squeezed, the nipples may secrete fluid.

What Are the Causes of Abnormal Nipple Discharge?

There are many causes of nipple discharge. These include:

Duct Ectasia:

This is a noncancerous (benign) condition in which the ducts under the nipple enlarge due to inflammation and become clogged with thick discharge. It usually occurs in women after menopause. The discharge can be green, brown, black, or very thick and have a cheese-like consistency. It usually affects both the breasts. In most cases, no treatment is required; hot packs can relieve any discomfort. However, the ducts can be removed surgically if the discharge is annoying.

Duct Papilloma:

A duct papilloma is a noncancerous growth within a milk duct in the breast, usually near the nipple. It may remain primarily asymptomatic or cause discharge from the nipples that are clear or blood-stained. It usually involves a single milk duct and is from one breast. They are the most common reason women experience abnormal nipple discharge. Rarely, duct papillomas can be associated with breast cancer called ductal papilloma in situ.

Nipple Eczema:

Eczema or dermatitis can cause a weeping, crusty nipple discharge when the skin of the nipple becomes infected. Cortisone-based creams are the first-line treatment, which is similar to eczema treatment.

Breast Cancer:

Breast cancer is a rare cause of nipple discharge. Nipple discharge can be an early sign of breast cancer. Less than 5 percent of women with breast cancer have nipple discharge.

Paget's Disease of the Nipple :

Paget's disease is an uncommon type of breast cancer that involves the nipple. Paget's disease typically causes ulceration, scaling, or flaking of the nipple skin, with a blood-stained nipple discharge.

Galactorrhoea:

Galactorrhoea can occur in anyone, regardless of sex or age. It causes milky nipple discharge, not related to pregnancy or breastfeeding. Instead, it is caused by the increased production of a hormone called prolactin. This is a hormone involved with breast growth and breastfeeding. Galactorrhea is not a disease and has many possible causes.

These include:

• Pituitary gland tumors.

• Hypothyroidism.

• Herbs such as fennel and anise.

• Hormones and psychotropic drugs.

• Illegal drugs such as marijuana.

Fibrocystic Breast Changes:

The presence or development of fibrous tissue and cysts is called fibrocystic breast. It may cause lumps or thickenings in the breast tissue. The fibrocystic breast can cause pain, itching, and rarely clear, white, green, or yellow nipple discharge.

What Is the Connection Between Cancer and Nipple Discharge?

Most nipple discharges are either normal or are caused by a noncancerous medical condition. In the case of breast cancer, the discharge will probably come from one breast (unilateral) and mostly accompanied by a lump. Discharge from the breast may be a symptom of some forms of cancer like ductal carcinoma in situ (DCIS), an early form of breast cancer that develops within the ducts of the breast located beneath the nipple, or with Paget's disease, a rare type of breast cancer involving the nipple. It can cause the nipple and the surrounding areola to bleed. Therefore, it is advisable to get checked for breast discharge, especially if it is a new symptom.

How Is Nipple Discharge Diagnosed?

The diagnosis of nipple discharge is based on the medical history and physical examination. The tests used to identify the cause of the discharge includes:

• Imaging: Tests including mammography (breast X-ray used to identify any abnormal growth or changes), MRI (magnetic resonance imaging), and ultrasound can help identify any abnormal changes, thus helping in identifying the cause.

• Biopsy: If the imaging tests or physical examination show any abnormalities, the doctor advises a biopsy, in which a sample of breast tissue is examined.

• Blood tests: A blood test is recommended to measure hormone levels.

What Is the Treatment for Nipple Discharge?

The treatment options for nipple discharge depend on the cause of the discharge. Some cases, such as discharge in later pregnancy or physiological discharge, do not require treatment. Nipple discharge that is spontaneous, blood-stained, persistent, and unrelated to pregnancy or breastfeeding must be investigated further. Nipple discharge from breast cancer often occurs when the tumor is in the initial stage; understanding it and providing prompt treatment helps to reduce the consequences.

The treatment depends on the cause of nipple discharge and may include:

• In case of infections, antibiotics are recommended. If an abscess is present, it needs to be drained.

• In the case of fibrocystic disease, aspiration (withdrawing fluid through a needle) of the breast cyst or cysts can solve the problem.

• Intraductal papillomas are symptomatic and can be removed surgically.

• Mammary duct ectasia does not require any specific treatment; warm packs ease the discomfort until the condition fades away on its own.

• Breast cancer requires surgery, radiation, chemotherapy, and hormone therapy.

Conclusion :

Nipple discharge cannot always be a cause of concern; it can occur in anyone during pregnancy and menopause. The nature of the discharge and associated symptoms can help determine the cause of nipple discharge. If the discharge is spontaneous and persistent, do consult the physician. Treatment depends on the cause of the discharge.