Nipple discharge

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]

• Galactorrhea
  • Endocrine-related: hyperprolactinemia , primary hypothyroidism
  • Chronic nipple stimulation; (e.g., piercings; , tight clothing, etc.)
• Non-milky nipple discharge
  • Benign causes: intraductal papilloma (52–57% of cases); , mammary duct ectasia; , fibrocystic changes, breast abscess
  • Malignancy; : 5–15% of cases (mostly ductal carcinoma in situ)

• Patient history
• Galactorrhea
  • HCG to exclude pregnancy
  • Prolactin level
  • TSH level
• One-sided and/or non-milky discharge
  • Mammogram (in woman > 30 years)
  • Subareolar ultrasound (in woman < 30 years)

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.

• Galactorrhea
  • See “Therapy” in hyperprolactinemia.
  • In the case of normoprolactinemic galactorrhea: Reassurance and avoidance of nipple stimulation
• Non-milky nipple discharge: : Treatment depends on the underlying disorder and can be found under respective causes (e.g., terminal ductal excision in the case of intraductal papilloma).

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