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Nipple discharge

Last updated: January 21, 2021

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Nipple discharge in non-lactating women can be classified as either galactorrhea or non-milky nipple discharge. Galactorrhea is usually caused by hyperprolactinemia and is associated with endocrine disorders or medication. Most of the causes of non-milky nipple discharge are benign, with less than 15% of cases related to cancer. The diagnostic approach is based on patient history and the characteristics of the discharge. Spontaneous, unilateral, and/or bloody nipple discharge, especially in women older than 40 years, should raise suspicion of malignancy. Treatment depends on the underlying disorder.

  • Lactation: normal milk production in breastfeeding women
  • Galactorrhea: milk production in non-breastfeeding women or men [1]
    • Discharge varies in color (clear, white, yellowish, or greenish)
    • Expressed from either or both breasts
  • Non-milky nipple discharge: production and secretion of fluids other than milk [2]

Signs that suggest malignancy

  • Spontaneous, unilateral; , uniductal, and bloody, or guaiac-positive discharge
  • Presence of a breast mass or abnormalities in imaging
  • Age > 40 years

Biopsy is mandatory if malignant disease is suspected.

  1. Galactorrhea. https://fpnotebook.com/Gyn/Sx/Glctrh.htm. Updated: January 1, 2018. Accessed: March 7, 2018.
  2. Nipple Discharge. https://fpnotebook.com/Gyn/Sx/NplDschrg.htm. Updated: January 1, 2018. Accessed: March 7, 2018.
  3. Dirbas F, Scott-Conner C. Breast Surgical Techniques and Interdisciplinary Management. Springer Science & Business Media ; 2011