Definition and Overview

Nipple discharge refers to any fluid that leaks from one or both nipples. While discharge can be alarming, it's important to know that it's the third most common breast complaint after lumps and pain, and in most cases, it has a benign (non-cancerous) cause. The discharge can vary in color, consistency, and amount, and these characteristics help determine the underlying cause.

The nature of nipple discharge provides important diagnostic clues. Normal discharge is usually bilateral (from both breasts), involves multiple ducts, and occurs only with nipple compression. Concerning discharge is typically spontaneous (occurs without squeezing), comes from a single duct, is persistent, and may be bloody or clear. The color can range from milky white to yellow, green, brown, or bloody.

Understanding when nipple discharge is normal versus abnormal is crucial. During pregnancy and breastfeeding, milky discharge is expected. Some medications and hormonal changes can also cause discharge. However, spontaneous discharge, especially if bloody or occurring in only one breast, warrants prompt medical evaluation to rule out serious conditions including cancer.

Common Causes

Benign Breast Conditions

  • Fibrocystic breast disease: Common benign changes
  • Mammary duct ectasia: Dilated milk ducts
  • Intraductal papilloma: Benign growth in duct
  • Fibroadenoma: Benign breast tumor
  • Breast cysts: Fluid-filled sacs
  • Ductal hyperplasia: Cell overgrowth
  • Periductal mastitis: Duct inflammation
  • Breast trauma: Injury-related discharge

Hormonal and Systemic Causes

  • Galactorrhea: Milky discharge unrelated to nursing
  • Pregnancy/breastfeeding: Normal lactation
  • Prolactinoma: Pituitary tumor
  • Thyroid disorders: Hypo/hyperthyroidism
  • Medications: Antipsychotics, antidepressants
  • Birth control pills: Hormonal effects
  • Breast stimulation: Physical stimulation
  • Stress: Can affect hormones

Concerning Causes

  • Breast cancer: Ductal or invasive
  • Paget's disease: Cancer of nipple
  • DCIS: Ductal carcinoma in situ
  • Mastitis: Breast infection
  • Breast abscess: Pus collection
  • Phyllodes tumor: Rare breast tumor
  • Male breast cancer: Rare in men

Types of Discharge and Associated Symptoms

Discharge Characteristics

  • Milky: Often hormonal
  • Clear/watery: May be concerning
  • Yellow/green: Often benign
  • Brown/rust: Old blood
  • Bloody: Requires evaluation
  • Thick/sticky: Duct ectasia
  • Purulent: Infection
  • Serous: Straw-colored

Associated Symptoms

When to Seek Medical Attention

See a healthcare provider promptly for:

  • Bloody or blood-tinged discharge
  • Clear discharge from one breast only
  • Spontaneous discharge (without squeezing)
  • Discharge from a single duct
  • Persistent discharge lasting weeks
  • Discharge with a breast lump
  • Nipple or skin changes
  • Discharge in men (always concerning)
  • Discharge in non-lactating women
  • Any discharge after menopause
  • Associated constitutional symptoms

Important: While most nipple discharge is benign, bloody discharge or discharge from one breast requires immediate evaluation.

Diagnostic Approach

Healthcare providers evaluate nipple discharge through:

Diagnostic Tests

  • Clinical breast exam: Physical examination
  • Mammography: Breast X-ray imaging
  • Breast ultrasound: Sound wave imaging
  • Ductography: Contrast study of ducts
  • MRI: Detailed breast imaging
  • Cytology: Discharge cell analysis
  • Blood tests: Prolactin, thyroid hormones
  • Biopsy: If abnormality found

Treatment and Management

Conservative Management

  • Observation for benign discharge
  • Stop nipple stimulation
  • Wear well-fitting bra
  • Breast pads for leakage
  • Medication review/changes
  • Treat underlying conditions
  • Regular monitoring
  • Lifestyle modifications

Medical Treatments

  • Antibiotics for infections
  • Hormone therapy adjustments
  • Prolactin-lowering drugs
  • Surgery for papillomas
  • Duct excision if needed
  • Cancer treatment if malignant
  • Drainage of abscesses
  • Treatment of thyroid disorders

Self-Care and Monitoring

Important self-care measures:

  • Keep a diary: Note discharge characteristics
  • Avoid manipulation: Don't squeeze nipples repeatedly
  • Monthly breast exams: Know what's normal
  • Proper hygiene: Keep nipples clean and dry
  • Document changes: Color, amount, frequency
  • Medication list: Share with doctor
  • Regular screening: Mammograms as recommended
  • Prompt evaluation: Don't delay if concerned
  • Support garments: Comfortable, supportive bras
  • Stress management: Can affect hormones