Women's Health

Breast Care

Breast Disorders

Nipple Discharge

Nipple discharge is a common breast symptom and one that can be particularly alarming when first discovered. There are many underlying causes of nipple discharge. The breast specialist’s job is to differentiate the serious underlying causes of nipple discharge from those that do not require any further evaluation. Benign conditions such as fibrocystic change, duct ectasia, and periductal mastitis can all create nipple discharge that emanates from both breasts and is generally present from more than one duct. The discharge is usually cloudy and may be green, dark or gray. This type of discharge generally is present with manipulation of the nipple and occasionally can be stimulated by taking a shower.

Generally, a complete breast exam and a close examination of the nipple discharge will be done to determine what may be causing the discharge. A mammogram and an ultrasound, that would evaluate the main milk ducts behind the nipple, may be used.

If the discharge is not concerning and the mammogram and ultrasound show no suspicious findings, then you can be assured that there is no problem.

Women who develop a discharge that is spontaneous, that is, does not require manipulation to identify, and comes from a single breast and usually a single duct will need more extensive evaluation. This discharge is generally clear yellow, also called serous, or bloody. Although this type of discharge does not mean there is an underlying breast cancer, it is very important to have an extensive evaluation so it can be excluded.

A complete breast examination as well as a mammogram and ultrasound may be performed. In many cases the discharge will not be associated with any underlying abnormality on mammogram or ultrasound. For a discharge from a single duct in one breast a ductogram is very helpful to evaluate the lining of the offending milk duct. This procedure involves placing a small catheter into the opening of the duct and injecting a contrast material which will outline the duct providing a roadmap picture. A mammogram is then taken to define the duct anatomy.

In the vast majority of cases the discharge is related to underlying growth in the duct called a papilloma. Papillomas are rarely malignant but generally will require a surgical procedure to remove the duct containing the papilloma to insure there is no underlying early form of breast cancer.