Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 17-03: Nipple Discharge + Key Features Download Section PDF Listen +++ ++ Common causes in the nonlactating breast Duct ectasia Intraductal papilloma Carcinoma Characteristics of nipple discharge and their clinical significance in nonpregnant, nonlactating women Serous: Most likely benign fibrocystic condition, ie, duct ectasia Bloody: More likely neoplastic–papilloma, carcinoma Associated mass: More likely neoplastic Unilateral: Either neoplastic or non-neoplastic Bilateral: Most likely non-neoplastic Single duct: More likely neoplastic Multiple ducts: More likely fibrocystic condition Milky: Endocrine disorders, medications Spontaneous: Either neoplastic or non-neoplastic Produced by pressure at single site: Either neoplastic or non-neoplastic Persistent: Either neoplastic or non-neoplastic Intermittent: Either neoplastic or non-neoplastic Related to menses: More likely fibrocystic condition Premenopausal: More likely fibrocystic condition Taking hormones: More likely fibrocystic condition + Clinical Findings Download Section PDF Listen +++ ++ Unilateral, spontaneous serous, or serosanguineous discharge from a single duct caused by Ectatic duct Intraductal papilloma (usually) Intraductal cancer (rarely) Bloody discharge suggests cancer but is more often due to benign papilloma in duct Fibrocystic condition in premenopausal women characterized by spontaneous, brown or green discharge From multiple ducts Unilateral or bilateral Most marked just before menstruation Milky discharge from multiple ducts occurs from Hyperprolactinemia Certain drugs (antipsychotics) A clear, serous, or milky discharge from single or multiple ducts Can occur with oral contraceptives or estrogen replacement therapy Disappears when patient stops taking the medication More evident just before menstruation Purulent discharge may originate in a subareolar abscess + Diagnosis Download Section PDF Listen +++ ++ If unilateral discharge from single duct, involved duct can be identified by pressure at different sites around nipple at margin of areola Check serum prolactin and thyroid-stimulating hormone levels if discharge is milky Mammography and ultrasound may be helpful if localization of lesion is not possible Differential diagnosis Galactorrhea (eg, pregnancy, postpartum, hyperprolactinemia) Mammary duct ectasia Intraductal papilloma Breast cancer Oral contraceptives or estrogen replacement therapy Fibrocystic condition Subareolar abscess + Treatment Download Section PDF Listen +++ ++ Any mass or, in the case of duct ectasia or intraductal papilloma, any involved duct should be excised Abscesses require drainage or removal along with the related lactiferous sinus When localization is not possible, no mass is palpable, and discharge is nonbloody, the patient should be reexamined every 3 or 4 mo for 1 yr, and mammography and ultrasound are performed