What is Breast Nipple Discharge?
Nipple discharge refers to any fluid that comes out of one or both nipples in a person who is not pregnant or breastfeeding. This condition can be quite a puzzle for doctors to figure out, as it can be normal or a sign of various medical conditions. Each breast has 15 to 20 milk ducts, and the discharge can come from one or several of these ducts.
The main concern for both the person experiencing it and the doctor is that nipple discharge might be a symptom of breast cancer. A growing number of women, more aware of breast cancer, are consulting their doctors about nipple discharge. Therefore, doctors need to be well-informed and skilled in examining this condition. It’s not uncommon to see patients with this issue in emergency rooms. The discharge can be harmless (physiological discharge) or indicate a medical problem.
Nipple discharge is considered normal in the last few weeks of pregnancy, after childbirth, and during breastfeeding. It may also occur in women who are not pregnant or breastfeeding, particularly during their reproductive years. Some actions like fondling or massaging the breast can stimulate the milk ducts to release fluid. Even stress can cause nipple discharge. However, nipple discharge in postmenopausal women is always significant and needs further investigation. In men, any nipple discharge is always abnormal and warrants a medical examination.
What Causes Breast Nipple Discharge?
Almost all nipple leaks or discharges are harmless and are not cause for concern (97%).
Everyday Causes of Nipple Discharge:
1. Pregnancy
2. Breastfeeding
3. Milk production up to two years after giving birth
4. After an ended pregnancy, whether it ended naturally or was ended intentionally
5. Changes in the breast tissue due to cysts
6. Hormone changes during the menstrual cycle
7. Widening of a milk duct
8. Benign but potentially troublesome growth inside a milk duct
Disease-related Causes of Nipple Discharge:
1. Infection of the area surrounding the milk ducts
2. Abscess or pus-filled lump in the breast
3. Cancerous growths of the breast like intraductal carcinoma and breast-related Paget’s Disease
4. Tumor in the pituitary gland
5. Injuries to the chest or breast
6. Body-wide diseases that increase the level of the hormone prolactin, like conditions affecting the thyroid, pituitary gland, hypothalamus, or long-term kidney or liver diseases
7. Side effects from medications that decrease dopamine, including opioids, birth control, blood pressure medication, antidepressants, and antipsychotics.
Risk Factors and Frequency for Breast Nipple Discharge
Nipple discharge is the third most reported issue related to the breasts, following breast pain and lumps in the breast. Around half to 80% of women during their childbearing years experience nipple discharge. Out of these, about 6.8% are sent to a breast surgeon for further examination. However, it’s important to note that the majority of nipple discharge cases, about 97%, are harmless and not a cause for concern.
Signs and Symptoms of Breast Nipple Discharge
The process of diagnosing whether nipple discharge is benign or harmful involves careful examination of a patient’s medical history. Women over 40 are at a higher risk of having harmful discharge, and postmenopausal women often have harmful discharges. Determining factors include when the discharge started and its characteristics like color, consistency, and whether it’s linked to the menstrual cycle.
A patient’s reproductive history, such as when they began menstruation or menopause and their past pregnancies, is significant. Past breast issues or surgeries also play a role, as does the patient’s family history with cancers, specifically of the breast and ovaries. It’s also crucial to consider the menopausal status of close relatives.
Medications can sometimes cause discharge as a side effect, so a history of prescription drugs used is essential. Check for signs of fever, hypothyroidism, liver disease, and pituitary tumors as they could help narrow down the discharge’s cause.
Physical examination involves looking for any breast masses, asymmetry, and changes in the skin. The exam then progresses to feeling the breasts and surrounding areas for any unusual lumps, swelling, or tenderness. If the examiner doesn’t observe any discharge, they may gently press from the outer breast towards the nipple to see if any discharge can be produced.
Typically, benign discharge is clear, comes from multiple ducts, and is from both breasts. It should not be sticky. On the other hand, harmful discharge is usually from one breast, spontaneous, and can vary in appearance. It tends to come from a single duct and is often accompanied by other abnormalities such as a lump, swelling, redness, or changes in the skin or nipple.
Testing for Breast Nipple Discharge
If you go to the emergency room with nipple discharge, the main goal is to figure out if it’s due to a harmless condition or if it’s a sign of something more serious like breast cancer or an infection. If you are young, and your other medical information suggests the discharge is harmless, you might be sent home and asked to see your regular doctor soon. But if there are reasons to be concerned about your discharge, you may need to see a breast specialist quickly.
The discharge’s characteristics can help doctors tell if it’s natural or sign of a disease. Natural discharge usually happens in both breasts and is either clear or milky, while discharge due to a possible illness typically happens only in one breast and may have blood. Other factors like the discharge’s color, whether it happens on its own or when the nipple is pressed, and any other symptoms you’re experiencing are also taken into account.
If your discharge might be natural, doctors will check your thyroid and prolactin hormone levels to see if other body processes could be responsible. If you’re under 40, regular observation will usually be enough. If you’re over 40, you might need a mammogram. In cases where the discharge might signal health problems, you would undergo a mammogram and/or ultrasound. If something abnormal shows up, you’ll need a breast biopsy. If not, you might need an MRI, or the doctor might take out a lump if there is one. Fluid analysis can also help identify cancerous cells if there’s blood in the discharge and breast cancer is suspected.
If you have signs of a breast abscess, you may need an urgent ultrasound and medical opinion about the general condition of your breast. Depending on the ultrasound results and what surgeons find, you might need to go to the operating room to have the abscess drained. But draining a breast abscess in the emergency room is generally discouraged because it is a painful procedure and the breasts are an area of aesthetic concern, especially when the nipple area is affected. Appropriate pain relief, ideally in the operating room, is necessary to minimize discomfort and maintain appearance.
Treatment Options for Breast Nipple Discharge
The treatment for breast discharge varies depending on the cause. If the discharge is a natural body process, no treatment is needed. If it’s caused by a medical condition, specific medications might be necessary. If the discharge is due to benign (non-cancerous) changes in the breast, like duct enlargement, a surgery that removes one or all of the ducts might be needed. A type of benign tumor called a duct papilloma, which can cause one-sided bloody discharge, also necessitates removing one duct.
On the other hand, breast cancer could also lead to bloody nipple discharge. If this is the cause, treatment options could include surgery, chemotherapy, or radiation, depending on how advanced the cancer is. If the discharge is pus-like, antibiotics are usually the correct treatment. However, if an abscess, or a pus-filled swelling, has developed, it might need to be drained through a surgical procedure, and a tissue sample from the abscess wall may be taken for further examination.
What else can Breast Nipple Discharge be?
- Breast duct growth (Intraductal papilloma)
- Swelling of the milk ducts in the breasts (Duct ectasia)
- Changes in breast tissue or breast infection (Fibrocystic changes and mastitis)
- Type of breast cancer that starts in the breast’s milk ducts (Intraductal carcinoma)
- Rare type of cancer affecting the nipple (Paget’s disease of the nipple)
What to expect with Breast Nipple Discharge
Typically, nipple discharge is caused by a small benign growth, known as an intraductal papilloma. Patients tend to have a very positive outcome when this growth is surgically removed.
Preventing Breast Nipple Discharge
Nurses, doctors, and pharmacists play a crucial part in teaching patients with nipple discharge and their families about this condition. It’s important that the healthcare team gives patients all the necessary information about what they’re experiencing and what treatments are available. This includes having clear conversations about what their treatment plan will involve and what other options might be available.
Patients should also receive written information about their condition. If possible, the nurse should suggest educational websites for the patients and their families to visit. This can help improve their understanding of the condition and its implications.