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Nipple Discharge (Non-Lactating)

The function of breasts is to produce milk. Sometimes a woman makes milk even when she is not breast-feeding. This is called galactorrhea. Women are more prone to nipple discharge at puberty and just prior to menopause. A woman with inverted nipples may have a discharge caused by dried sweat and/or debris becoming trapped in the nipple. Just by squeezing the nipple, the hormone prolactin is activated and can initiate or increase a discharge. Breast discharge in men is uncommon and should be checked by a doctor. If a mass is found, the patient should have a mammogram and/or a biopsy.

Nipple discharge is a concern when

  • It is bloody or watery, feels sticky, or is pink, red, or black in color
  • It appears spontaneously, without squeezing or irritating the nipple
  • It is one-sided and persists
  • It is accompanied by acne and growth of hair on the chin or chest
  • It is accompanied by menstrual periods that are irregular or absent
  • It is accompanied by blurred vision and headache


Causes of nipple discharge

  • Papillomas (wart-like growth inside the milk duct)
  • Duct ectasia (widening and hardening of the duct due to age or damage)
  • Hormonal imbalance
  • Benign tumors (especially of the pituitary gland)
  • Chronic kidney disease
  • Pregnancy
  • Clothes that irritate the breast
  • Breast stimulation during sexual activity
  • Medications such as hormones, blood pressure medications, antidepressants, marijuana, opiates, drugs that inhibit acid secretion in the stomach (Zantac, Prilosec)
  • Herbs such as nettle, fennel and anise


Diagnosis
The fluid discharge is often examined under a microscope to detect abnormal cells. This can be collected by your doctor or surgeon in the office. A mammogram is typically performed to screen for any signs of cancer. Ultrasound is sometimes used to evaluate the ductal system around the nipple. The radiologist can examine the duct system with an x-ray called a ductogram. This x-ray can identify the most common causes of nipple discharge.

Treatment for persistent nipple discharge
The most common treatment for persistent discharge without hormone involvement is duct excision. This is performed under local anesthesia by a surgeon on an outpatient basis. A small incision is made around the areola (colored area of the breast), and the duct is removed.

Note: Any discharge associated with a breast lump, skin changes, nipple changes or abnormal mammogram should be referred to a surgeon.