Nipple Discharge

What it is

Nipple discharge outside of pregnancy and breastfeeding is a common complaint and, in most cases, benign. Discharge triggered by compression, milky, greenish or yellowish in color, coming from several ducts and from both breasts, is usually linked to duct ectasia, fibrocystic changes, medications or increased prolactin. Spontaneous, persistent discharge from a single breast and a single duct, clear like water or bloody, needs to be investigated, as it can be caused by an intraductal papilloma and, rarely, by more serious lesions. The assessment includes a clinical exam, ultrasound, mammography according to age and, when indicated, analysis of the discharge and MRI. Treatment depends on the cause and ranges from simple observation to surgical removal of the affected duct.

Most common symptoms

• Fluid coming from the nipple outside of pregnancy and breastfeeding
• Milky, yellowish or greenish discharge with compression, on both sides
• Spontaneous discharge that stains the bra without squeezing the breast
• Fluid clear as water or bloody, from a single duct
• A small lump or tenderness behind the areola
• Associated menstrual irregularity, when prolactin is elevated

Causes and risk factors

• Duct ectasia and fibrocystic changes
• Intraductal papilloma, the leading cause of bloody discharge
• Elevated prolactin, from medications or pituitary changes
• Antidepressants, antipsychotics, hormones and other medications
• Frequent nipple stimulation and hypothyroidism
• Rarely, more serious lesions, which investigation rules out

How it is diagnosed

At the consultation, your breast specialist asks whether the discharge is spontaneous or triggered, from one or both breasts, from one or several ducts, and checks its color and appearance on clinical exam. Ultrasound, performed on site, looks for dilated ducts or lesions inside them; mammography is ordered depending on age. When the discharge is suspicious, analysis of the fluid, MRI and ultrasound-guided biopsy complete the investigation. A prolactin blood test is included in cases of milky discharge from both sides.

How we treat it at Femi Saúde

Treatment depends on the cause. Discharge that is triggered, comes from several ducts and both breasts, is usually benign and needs only guidance, such as avoiding nipple stimulation, and periodic follow-up. When prolactin is elevated or a medication is involved, the breast health team at Femi Saúde adjusts the approach together with gynecology or endocrinology. Spontaneous discharge from a single duct, clear or bloody, is investigated with imaging and biopsy; when a papilloma is identified or the cause remains unclear, surgical removal of the affected duct may be indicated, with a discreet incision around the areola. The plan is individualized.

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