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.