Nipple discharge

Many women can express small amounts of fluid from their nipples and this is not abnormal. We become concerned when the discharge occurs spontaneously (without any squeezing or massaging of the breast) and particularly if it occurs repeatedly and involves a single duct.

Causes for nipple discharge:

Duct papilloma - The most common cause for single duct discharge is a small benign growth within the duct called an intraduct papilloma.

Duct ectasia - is a benign change in the major ducts under the nipple. Over time the ducts become widened and twisted and slowly fill with secretions. This can cause quite profuse nipple discharge often from multiple ducts. The fluid ranges in colour from green to dark brown. If the discharge becomes a problem the major ducts can be excised.

Cancer - Occasionally nipple discharge is due to breast cancer so careful assessment of the breast is important as with any new breast symptoms.

Assessment should include a clinical exam, and ultrasound plus mammography if appropriate.

A sample of the nipple fluid can be sent for examination in the laboratory  but results seldom help in making a diagnosis.

A ductogram is a radiology procedure that involves passing a small cannula into the discharging duct and then injecting contrast media to see if there is any filling defect or obstruction to the duct. I have not found this helpful as it does not explain what is causing the obstruction.

The diagnosis is made by excising the affected duct in theatre and sending the tissue for examination. This operation is called a microdochectomy, which is a difficult way of sayng "excision of a small duct"

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