Nipple discharge

Nipple discharge is a common complaint. It’s the third most common symptom of breast for which consultation is sought after lump & pain . It is referred to the fluid that that comes out of breasts of non breast feeding / non pregnant women. It originates from one or more ducts of the breast. Patients usually panic if they detect nipple discharge but one should understand that less than 10% of nipple discharges are symptoms of cancer. So up to 90% discharges are related to non cancerous conditions.

Broadly it can be

1 Normal discharge (physiological ) due to :

2 Galactorrhoea

3 Nonbenign discharge (pathological)

Types of discharge(colour)

Milky/ multicoloured/ sticky/ purulent(pus)/ clear/watery /yellow /bloody

Diagnosis of nipple discharge

Diagnosis will be made in a Breast Clinic .The Breast Specialist will take the following things into consideration :

Good physical examination (CBE) by a breast specialist is done

Tests that may be ordered as per requirement :TSH/ PRL/Dynamic MRI of pituitary fossa/ cytology of nipple discharge.

SOME SPECIAL CAUSES OF NIPPLE DISCHARGE

Galactorrhea (milky discharge)

It’s a milky discharge unrelated to pregnancy and is present on both sides.

Most common reason is a hormonal upset, a pituitary adenoma, certain medicines (psychiatric/ acidity)

Intraductal breast papilloma

This presents as a single duct bloody discharge which is most often spontaneous(occurring on its own ). Diagnosis is made by clinical history, examination and radiology (ultrasound). Cytology examination may not throw light on the condition and hence not reliable.

Treatment is through surgical excision by a Breast Surgeon.

Duct ectasia

This is a condition where there is dilatation of ducts below the areola (black area below the nipple).generally the patient complains of cheesy or thick discharge from the nipple. Chronic infection/ inflammation of the duct may cause the nipple retraction (indrawing.)There may be fish mouthing of the duct at the nipple. Treatment is by CBE, mammography/ ultrasound/ cytology of the discharhe.

Patient may be reassured and closely followed up. The surgical procedure is Microdocectomy procedure by a Breast Surgeon.

Ahuja Clinic is a Breast Clinic where both doctors are Breast Specialists in Chandigarh . Dr Ruchi Rai Ahuja is a Gynaecologist with degree in breast and Dr Alok Ahuja is a Breast Surgeon in Chandigarh. Here all treatments for breast related problems are handled by experienced doctors.