Nipple discharge affects many women who are not pregnant or breastfeeding and the presence of

breast secretions do not always indicate any serious problem. While breast milk is expected in
pregnancy and after child birth, other secretions from the breast may also occur in women of any
age. Young women may experience nipple discharge without any cause for concern but
persistent discharge in older women may be a sign of an underlying condition.
Secretions from the breast usually occur from the nipple and nipple discharge should be
differentiated from fluids secreted through a breast fistula. A breast or mammary duct fistula is
an abnormal passage that forms between a mammary duct in the breast to the surface of the skin,
usually near the areola. While a mammary fistula is not very common, it may occur after a
prolonged infection and the presence of a fistula should not be considered as nipple discharge. A
breast fistula requires further investigation and appropriate treatment.

Types of Nipple Discharge

There are different types of nipple discharge and the type of breast secretion may be an
indication of the cause of the discharge.
Milky discharge may be breast milk production even in women who are not pregnant or
breast feeding and is often due to elevated hormonal levels, specifically prolactin.
Clear discharge and sticky discharge may be a sign of inflammation or infection.
Bloody discharge may be a sign of severe trauma, infection or cancer.
Mucus that is yellow or brown and may be mixed with blood could be due to severe
infection, especially if accompanied by breast pain.
Evaluating the type of nipple discharge is not usually sufficient to make a conclusive diagnosis.
The presence of other signs and symptoms as well as thorough diagnostic investigation by a
medical practitioner should determine the underlying cause of the breast discharge.

Signs and Symptoms of Nipple Discharge

Nipple discharge may occur on its own with no other sign or symptoms or may be accompanied
by other symptoms which is indicative of certain conditions.
Nipple discharge may occur from both breasts (bilateral) or one breast (unilateral)
Breast tenderness or breast pain
Swollen breasts or breast lumps
Fever
Irregular menstrual cycle

Causes of Nipple Discharge

In most cases, breast discharge is not a cause for concern but any persistent discharge associated
with other changes requires investigation. Any nipple discharge in males needs to be investigated
as it is usually an indication of more serious pathology.
Galactorrhea is breast milk production in women who are not pregnant or nursing and is
often due to elevated prolactin levels (hyperprolactinemia). Hyperprolactinemia may
occur as a result of many conditions including :
1. Stimulation of the breasts
2. Pregnancy
3. Stress
 4. Injury to the breast
5. Sexual intercourse.
6. Pituitary disorders
7. Thyroid disorders particularly hypothyroidism
8. Kidney or liver failure
9. Certain drugs like oral contraceptives, antidepressants or antihypertensive drugs.
Breast abscess or breast infection due to bacterial, viral or fungal causes is usually
accompanied by breast pain, tenderness, redness of the skin with a white to yellow
discharge. A painful breast lump may be felt in the case of an abscess. Infections of the
breast are usually one sided and may also cause breast swelling.
Benign breast disorders :
1. Intraductal papilloma is a small benign tumor of the milk ducts in the breast. It is the
most common cause of nipple discharge and usually affects only one breast. The
secretion may be bloody or a clear discharge may be noted.
2. Fibrocystic breast disease (FBD) is the most common cause of breast lumps in women,
particularly older women. It may affect one or both breasts and the presence of multiple
small lumps may be noticed along with breast tenderness.
3. Mammary duct ectasia is the blockage of the milk duct and may affect one breast or both
sides. Blockage of the duct often occurs as a result of inflammation due to hormonal
changes and may be prone to bacterial infections. Smoking is a predisposing cause for
mammary duct ectasia. The nipple discharge in mammary ectasia may vary in color and
consistency.
Breast cancer, usually intraductal carcinoma, may cause a bloody breast discharge. A breast
lump is usually present and swollen lymph nodes (lymphadenopathy) may be noticed.
Hormonal disorders affecting the female sex hormones which may occur in perimenopause,
premature ovarian failure and polycystic ovarian syndrome. Changes in the menstrual
cycle are usually evident, with irregular menses, sudden cessation of periods or changes
in menstrual flow. Infertility may also accompany these hormonal disorders.
Gynecomastia is the enlargement of the male breast which may be normal during puberty.
Persistent enlargement with breast tenderness and/or nipple discharge should be
investigated although breast secretions in gynecomastia is not common.

Diagnosis of Breast Discharge

While nipple discharge may occur frequently in women who are not pregnant or breastfeeding,
persistent breast secretions should be investigated. Persistent breast discharge is of particular
concern in women over 40 years of age, where the discharge is from only one breast, bloody
discharge with the presence of breast lumps.
After physical examination and a case history, your medical doctor may consider a mammogram,
fine needle aspiration and cytology. If the prolactin levels are elevated, further blood tests may
be conducted to evaluate the functioning of the thyroid gland, particularly by testing the thyroid
stimulating hormone (TSH).
If you are using any hormone replacement therapy or related drugs for menopause, as
contraception or for infertility, your medical doctor may discontinue or change the drugs if the
breast discharge is severe and accompanied by other symptoms like breast swelling, tenderness
or pain.
Women experiencing nipple discharge with a personal or family history of recurrent breast
lumps, even benign lumps. should undergo extensive investigation to exclude breast cancer.