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Female Breast
Female Breast


Intraductal papilloma
Intraductal papilloma


Mammary gland
Mammary gland


Abnormal discharge from the nipple
Abnormal discharge from the nipple


Normal female breast anatomy
Normal female breast anatomy


Nipple discharge

Definition:

Nipple discharge is any fluid that comes out of the nipple area in your breast.



Alternative Names:

Discharge from breasts; Milk secretions; Lactation - abnormal; Witch's milk; Galactorrhea; Inverted nipple; Nipple problems



Causes, incidence, and risk factors:

Sometimes discharge from your nipples is okay and will get better on its own. You are more likely to have nipple discharge as you get older and if you have been pregnant at least once.

Nipple discharge is usually not a symptom of breast cancer. But it is important to find out what is causing it and to get treatment. Here are some reasons for nipple discharge:

  • Pregnancy 
  • Stopping breastfeeding
  • Rubbing on the area from a bra or t-shirt
  • Infection  
  • Inflammation and clogging of the breast ducts (mammary duct ectasia) 
  • Injury to the breast 
  • Non-cancerous brain tumors
  • Small growth in the breast that is usually not cancer (intraductal papilloma)
  • Severe hypothyroidism (underactive thyroid gland) 
  • Fibrocystic breast (normal lumpiness in the breast)
  • Use of certain medicines, such as birth control pills, cimetidine, methyldopa, metoclopramide, phenothiazines, reserpine, tricyclicantidepressants, or verapamil 
  • Use of certain herbs such as anise and fennel 
  • Widening of the milk ducts

Sometimes, babies can have nipple disharge. Your doctor or nurse will call this "witch's milk." It is caused by hormones from the mother before birth, and should go away in 2 weeks.

Cancers that can cause nipple discharge are:

  • Breast cancer
  • Paget’s disease of the breast (a rare form of breast cancer)


Symptoms:

Nipple discharge that is NOT normal is:

  • Bloody
  • Comes from only one nipple
  • Comes out on its own without you squeezing or touching your nipple

Nipple discharge is more likely to be normal if:

  • It comes out of both nipples
  • Happens when you squeeze your nipples

The color of the discharge does not tell you whether it is normal or not. The discharge can look milky, clear, yellow, green, or brown.

Squeezing your nipple to check for discharge can make it worse. Leaving them alone may make the nipple discharge go away.



Signs and tests:

Your doctor or nurse will examine you and ask questions about your symptoms and medical history.

Tests that may be done may include:



Treatment:

Once the cause of your nipple discharge is found, your doctor or nurse can recommend ways to treat it. You may:

  • Need to change any medicine that caused the discharge
  • Have lumps removed
  • Have all or some of the breast ducts removed
  • Receive creams to treat skin changes around the nipple
  • Receive medicines to treat an underlying health condition

If all of your tests are normal, may not need treatment. You should have another mammogram and physical exam within 1 year. 



Support Groups:



Expectations (prognosis):

In most cases, nipple problems are not breast cancer . These problems will either go away with the right treatment, or they can be watched closely over time.



Complications:

Nipple discharge may be a symptom of breast cancer or a pituitary tumor.

Skin changes around the nipple may be caused by Paget's disease.



Calling your health care provider:

If you are a man and have nipple discharge, make an appointment with your doctor or nurse right away.



References:

Melmed S, Kleinberg D, Ho K. Pituitary physiology and diagnostic evaluation. In: Melmed S, Polonsky KS, Larsen PR, KronenbergHM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa:Saunders Elsevier; 2011:chap 8.

Katz VL, Dotters D. Breast diseases: diagnosis and treatmentof benign and malignant disease. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL,eds. Comprehensive Gynecology. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2012:chap15.

Leitch AM, Ashfag R. Discharges and secretions of the nipple. In: Bland KI, Copeland EM III, eds. The Breast: Comprehensive Management of Benign and Malignant Disorders. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 4.

Gray RJ, Pockaj BA, Karstaedt PJ. Navigating murky waters: a modern treatment algorithm for nipple discharge. Am J Surg. 2007;194:850-854.




Review Date: 9/15/2012
Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc. Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine.

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