++
For further information, see CMDT Part 19-03: Nipple Discharge
++
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
++
Unilateral, spontaneous serous, or serosanguineous discharge from a single duct caused by
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
Milky discharge from multiple ducts occurs from
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 drugs
More evident just before menstruation
Purulent discharge may originate in a subareolar abscess
Differential diagnosis
Galactorrhea (eg, pregnancy, postpartum, hyperprolactinemia)
Mammary duct ectasia
Intraductal papilloma
Breast cancer
Oral contraceptives or estrogen replacement therapy
Fibrocystic condition
Subareolar abscess
++
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
++
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 of the discharge is not possible, no mass is palpable, and discharge is nonbloody, the patient should be reexamined every 3 or 4 months for 1 year, and mammography and ultrasound are performed