Nipple Discharge? Here’s What You Need To Know

Nipple discharge is a common condition which is experienced by a lot of females and in most cases it is benign/ non-cancerous in nature.

How nipple discharge is classified?

Nipple discharge is further classified into various types such as-

1.       Lactation

2.       Physiological (galactorrhea)

3.       Pathological.

Lactation is a normal process in which the ducts of the breast release milk in order to feed the newborn.

Galactorrhea on the other hand, is bilateral, milky, which involves multiple ducts. It occurs at least one year following cessation of breast feeding or pregnancy.

What are the causes of galactorrhea ?

It is most commonly caused due to hyperprolactinemia (excess of prolactin) and is also suggested by presence of amenorrhea (absence of menstruation/periods).

Hyperprolactenemia may occur in females due to various causes such as-

·         Medications

·         Primary tumors

·         Endocrine abnormalities.

Hypothyroidism or decrease in thyroid hormone production, chronic nipple stimulation and renal insufficiency are some less common causes associated with galactorrhea in females.

There are certain medications which may cause galactorrhea such as-

·         Antipsychotics

·         Methyldopa

·         Reserpine

·         Raglan

·         Cimetidine

·         Opioids

·         Antidepressants.

What Is pathological nipple discharge ?

Pathological nipple discharge is defined as oozing out of fluid from the nipples due to an underlying condition. It is usually unilateral or localized to a single duct.  It can be spontaneous, intermittent or persistent.

Most common cause is intraductal papilloma, followed by mammary duct ectasia.

The fluid discharged can be either serosanguinous, bloody, green or clear.

According to the researches, 10-15% of pathological nipple discharge is due to presence of breast carcinoma.

Purulent or pus filled discharge is mainly due to mastitis or infection of the breast.

When you visit a doctor your history must include the whole evaluation of your menstrual cycle, recent pregnancy, any medication usage, breast trauma and presence or absence of headaches or visual complaints.

Your doctor will examine the breast and nipple area in order to know the character of the discharge.

Usually an imprint slide is made for further cytopathological examination in order to obtain a diagnosis.

It is very important to know whether the discharge is from a single duct or multiple ducts.

What is the diagnostic testing?

If fluid discharging from the nipples are not containing blood on gross examination a test for occult blood is done to rule out the same.

There are some hormone level measurements which are investigated to rule out different causes of nipple discharge from multiple ducts. These are as follows-

·         Thyroid stimulating hormone

·         Prolactin

·         Creatinine

·         Pregnancy tests

There are various measures  which can be taken for further investigations such as-

·         Mammography

·         Ductography

·         Magnetic resonance imaging (MRI)

·         Ductoscopy

Duct excision is performed if any abnormality is identified in the above tests performed.

What is the treatment of nipple discharge?

For galactorrhea-

·         Patients having normal periods and normal hormone levels do not require any specific treatment.

·         Breast stimulation is not recommended in patients with galactorrhea.

·         If patient is consuming any medication that is leading to galactorrhea the drug dosage is usually decreased or stopped and the patient if followed for results and effects.

Patients who are suffering from pathological discharge must visit an experienced surgeon for evaluation and further management.

Hope you found it useful🙂

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