Breast: Nipple Discharge

Causes

• Physiologic (Benign) Nipple Discharge – Most Common (97%)
  • Pregnancy
  • Lactation
  • Postpartum Galactorrhea
  • Spontaneous Abortion
  • Fibrocystic Change
  • Hormonal Fluctuations with Menstrual Cycle
  • Prolactinoma (Pituitary Tumor)
  • Endocrinopathies that Increase Prolactin Levels
  • Medication Side Effects
• Pathologic Nipple Discharge
  • Mastitis/Abscess
  • Ductal Ectasia
  • Intraductal Papilloma – Most Common Cause of Pathologic Nipple Discharge (52-57%)
  • Neoplasia

“Pathologic” Discharge Factors

• Physiologic Factors:
  • Bilateral
  • Expressed
  • Small Amount
  • Multiple Ducts
  • White, Milky or Clear
    • Can Also Be Yellow (Straw Colored), Brown or Green
• Pathologic Factors:
  • Unilateral
  • Spontaneous
  • Copious in Amount
  • Single Duct
  • Bloody or Serous (Clear or Yellow)

Substances

• White/Milky – Galactorrhea
• Brown, Yellow or Green – Often Caused by Fibrocystic Change
• Bloody – Caused by Intraductal Papilloma (Most Common) or Ductal Cancers
• Serous – Concerning for Cancer

Diagnostic Evaluation

• Physiologic Discharge: Reassurance
  • Consider Galactorrhea Work Up (Pregnancy Test, Prolactin Level & Thyroid Function Tests)
• Pathologic Discharge: Imaging
  • Initial Imaging: Bilateral Diagnostic Mammogram & US
  • If Initial Imaging Negative: MRI
    • Could Also Consider Galactography/Ductogram
  • Other Considerations:
    • Cytology is Not Useful
    • Biopsy & Surgical Intervention as Indicated