On the Coast – Over 55 Issue 32 I November/December 2019(clone) | Page 6

Nipple discharge
With Dr Mary Ling, Central Coast Breast and General Surgeon
N
ipple discharge is when fluid leaks from the nipple. It is a
common breast symptom. Here are answers to 4 frequently
asked questions.
1
What are the features of nipple
discharge to look out for?
Nipple discharge can be
ƒ ƒ Spontaneous (fluid leaks without
any squeezing of the nipple) or on
expression (fluid comes out only when
the nipple is squeezed)
ƒ ƒ Unilateral (from one breast) or
bilateral (from both breasts)
ƒ ƒ Single duct (from one opening on the
nipple) or multiple ducts (from more
than one opening on the nipple)
ƒ ƒ Blood-stained, clear, green, milky or
yellow in colour
2
Can nipple discharge be normal?
Yes. Fluid can be obtained from
the nipples of around 70% of women
when special techniques, massage or
devices (e.g. breast pumps) are used. This
discharge of fluid from a normal breast is
called ‘physiological discharge’.
Physiological discharge is typically on
expression (rather than spontaneous),
comes from multiple ducts and yellow,
milky or green in colour.
Physiological discharge requires
no treatment. It is important to stop
expressing or squeezing the nipple and
breast, as this causes more fluid to be
made. The discharge will usually stop
when you stop expressing.
3
When is nipple discharge abnormal?
Spontaneous nipple discharge
unrelated to pregnancy or breastfeeding
is abnormal.
There are many causes of abnormal
nipple discharge, including
ƒ ƒ Duct ectasia: a benign condition
in which there is enlargement &
inflammation of the milk ducts under
the nipple
ƒ ƒ Duct papilloma: a growth
within the milk duct near the
nipple
ƒ ƒ Nipple eczema: dermatitis
affecting the skin of the
nipple
ƒ ƒ Paget’s disease of the nipple:
a type of breast cancer
involving the nipple
ƒ ƒ Breast cancer
Nipple discharge that is
spontaneous, blood-stained,
persistent and unrelated to
pregnancy or breastfeeding
requires clinical assessment
by your doctor and imaging of
the breasts with ultrasound
and mammogram (and
sometimes MRI).
4
Will I need surgery?
Surgery for nipple discharge is
required for
ƒ ƒ Diagnosis of blood-stained nipple
discharge even if imaging shows no
abnormality (as changes behind the
nipple can be difficult to see)
ƒ ƒ Treatment of the underlying disease
(e.g. papilloma, breast cancer)
ƒ ƒ Treatment of annoying discharge
caused by benign conditions
(e.g. duct ectasia)
Nipple discharge
associated with
other symptoms
such as a lump
or skin changes
always requires
investigation.
Dr Mary Ling is a Breast and General Surgeon who consults at Gosford, Woy Woy and Kanwal.
& 02 4321 0302
6
www.drmaryling.com.au
O N T H E C OA S T – OVER 5 5
@drmaryling
*This advice is general only.
All surgical procedures have
risks. Speak to your doctor
about your symptoms