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Nipple discharge

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

 

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

Causes

 

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

Nipple discharge is usually not cancer (benign), but rarely it can be a sign of breast cancer. It is important to find out what is causing it and to get treatment. Here are some reasons for nipple discharge:

  • Pregnancy
  • Recent breastfeeding
  • Rubbing on the area from a bra or t-shirt
  • Injury to the breast
  • Infection
  • Inflammation and clogging of the breast ducts
  • Noncancerous pituitary tumors
  • Small growth in the breast that is usually not cancer
  • Severe underactive thyroid gland (hypothyroidism)
  • Fibrocystic breast (normal lumpiness in the breast)
  • Use of certain medicines
  • Use of certain herbs, such as anise and fennel
  • Widening of the milk ducts

Sometimes, babies can have nipple discharge. This is caused by hormones from the mother before birth. It should go away in 2 weeks.

Cancers such as Paget's disease (a rare type of cancer involving the skin of the nipple) can also cause nipple discharge.

 

Symptoms

 

Nipple discharge that is NOT normal is:

  • Bloody
  • Comes from only 1 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. The discharge can look milky, clear, yellow, green, or brown.

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

 

Exams and Tests

 

Your health care provider will examine you and ask questions about your symptoms and medical history.

Tests that may be done 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 your nipple
  • Receive medicines to treat a health condition

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

 

Outlook (Prognosis)

 

Most of the time, 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

 

Have your health care provider evaluate any nipple discharge.

 

 

References

Gray RJ, Pockaj BA, Karstaedt PJ. Navigating murky waters: a modern treatment algorithm for nipple discharge. Am J Surg. 2007;194:850-4. PMID: 18005783 www.ncbi.nlm.nih.gov/pubmed/18005783.

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: Elsevier Mosby; 2012:chap 15.

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: Elsevier Saunders; 2009:chap 4.

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

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  • Female Breast

    Female Breast

    illustration

  • Intraductal papilloma

    Intraductal papilloma

    illustration

  • Mammary gland

    Mammary gland

    illustration

  • Abnormal discharge from the nipple

    Abnormal discharge from the nipple

    illustration

  • Normal female breast anatomy

    Normal female breast anatomy

    illustration

    • Female Breast

      Female Breast

      illustration

    • Intraductal papilloma

      Intraductal papilloma

      illustration

    • Mammary gland

      Mammary gland

      illustration

    • Abnormal discharge from the nipple

      Abnormal discharge from the nipple

      illustration

    • Normal female breast anatomy

      Normal female breast anatomy

      illustration

    A Closer Look

     

      Self Care

       

      Tests for Nipple discharge

       
         

        Review Date: 11/16/2014

        Reviewed By: Cynthia D. White, MD, Fellow American College of Obstetricians and Gynecologists, Group Health Cooperative, Bellevue, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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