- Mehra Golshan, MD
Mehra Golshan, MD
- Associate Professor of Surgery
- Harvard Medical School
- Dirk Iglehart, MD
Dirk Iglehart, MD
- Professor of Surgery
- Harvard Medical School
- Section Editor
- Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
- Section Editor — Breast Surgery
- Associate Professor, Department of Surgery
- Yale University School of Medicine
- Deputy Editor
- Don S Dizon, MD, FACP
Don S Dizon, MD, FACP
- Deputy Editor — Oncology and Palliative Care
- Medical Gynecologic Oncology
- Massachusetts General Hospital
- Gillette Center for Women's Cancers
- Associate Professor, Medicine & Obstetrics and Gynecology
- Warren Alpert Medical School of Brown University
Nipple discharge is the one of the most commonly encountered breast complaints . Approximately 50 to 80 percent of women in their reproductive years can express one or more drops of fluid [2,3] and 6.8 percent of women referred to a surgeon because of symptoms of a breast disorder have nipple discharge . Most nipple discharge is of benign origin.
The primary goals of evaluation and management are to differentiate patients with benign nipple discharge from those who have an underlying papilloma, cancer, or high-risk lesion, and to manage patients with underlying pathologic nipple discharge [5-7]. Isolated papillomas are usually benign, but can harbor areas of atypia or ductal carcinoma in situ (DCIS). (See "Breast ductal carcinoma in situ: Epidemiology, clinical manifestations, and diagnosis" and "Ductal carcinoma in situ: Treatment and prognosis".)
The clinical history is most helpful in distinguishing benign from suspicious or pathologic nipple discharge . Benign nipple discharge is usually bilateral, multiductal, and occurs with breast manipulation. Conversely, the risk of cancer is higher when the discharge is spontaneous, bloody or guaiac positive, unilateral, uniductal, associated with a breast mass, and/or occurs in a woman over 40 years of age.
The types of nipple discharge and how to evaluate and manage this common problem will be reviewed here.
TYPES OF NIPPLE DISCHARGE
Nipple discharge is categorized as normal milk production (lactation), physiologic nipple discharge, or pathologic (suspicious) based on the characteristics of presentation. Each category is discussed below.
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- TYPES OF NIPPLE DISCHARGE
- Physiologic nipple discharge
- - Medication related causes
- - Neurogenic stimulation
- Other causes
- Pathologic (suspicious) nipple discharge
- CLINICAL EVALUATION
- Physical examination
- - Bilateral discharge
- - Unilateral discharge
- Differential diagnosis
- - Straw-colored or clear transparent discharge
- - Grossly bloody discharge
- - Guaiac positive discharge
- - Staining of the bra without obvious nipple discharge
- DIAGNOSTIC EVALUATION
- Laboratory examination
- - Mammography
- - Ultrasound
- - Ductography
- - Magnetic resonance imaging
- - MR ductography
- Cytologic examination
- Ductal lavage
- Skin punch biopsy
- Medical treatment for physiologic nipple discharge
- Surgical treatment for pathologic nipple discharge
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS