Nipple Discharge

What is nipple discharge?

Nipple discharge is when fluid leaks from the nipple.

Nipple discharge can be

  • Spontaneous (fluid leaks from the nipple without any squeezing of the nipple) or on expression (fluids comes out of the nipple only when the nipple is squeezed)
  • Unilateral (from one breast) or bilateral (from both breasts)
  • Single duct (from one opening on the nipple) or multiple ducts (from more than one opening on the the nipple)
  • Blood-stained, clear, green, milky or yellow in colour

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.

When is nipple discharge abnormal?

Spontaneous nipple discharge unrelated to pregnancy or breastfeeding is abnormal. Nipple discharge caused by disease in the breast is more likely to be unilateral, confined to a single duct and clear or blood-stained in appearance. Nipple discharge associated with other symptoms such as a lump, skin or nipple changes always requires investigation, even if the discharge is not spontaneous or blood-stained.

What are the causes of abnormal nipple discharge?

There are many causes of nipple discharge, including

  • Duct ectasia: a benign condition in which there is enlargement and inflammation of the milk ducts under the nipple.
  • Duct papilloma: a growth within the milk duct near the nipple.
  • Nipple eczema: dermatitis (or eczema) affecting the skin of the nipple.
  • Paget's disease of the nipple: an uncommon type of breast cancer in which cancer cells grow in the nipple-areolar complex.
  • Breast cancer

Will I need surgery?

Surgery for nipple discharge is required for

  • Diagnosis of blood-stained nipple discharge even if imaging shows no abnormality (as changes behind the nipple can be difficult to see)
  • Treatment of the underlying disease (e.g. papilloma, breast cancer)
  • Treatment of annoying discharge caused by benign conditions (e.g. duct ectasia)

Nipple Discharge was published in On the Coast Families Magazine.