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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
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.
Exams 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:
- Prolactin blood test
- Thyroid blood tests
- Head CT scan or MRI to look for pituitary tumor
- Mammography
- Ultrasound of the breast
- Breast biopsy
- Ductography or ductogram, an x-ray with contrast dye injected into the affected milk duct
- Skin biopsy, if Paget's disease is a concern
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.
Outlook (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.
Possible 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.
When to Contact a Medical Professional
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.
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.
