Nipple Discharge

Nipple discharge is not a common symptom, but it should always raise the suspicion of breast disease, especially if the discharge occurs spontaneously. Any patient who describes a nipple discharge should be asked the following questions:

' 'What is the color of the discharge?'' ''Do you have a discharge from both breasts?'' ''When did you first notice the discharge?'' ''Is the discharge related to your menstrual cycle?''

''When was your last menstrual cycle?''

''Is the discharge associated with nipple retraction? a breast mass? breast tenderness?'' ''Do you have headaches?'' ''Are you taking any medications?'' ''Are you using oral contraceptives?''

If the woman has recently delivered a child, ask ' 'Were there any problems during the delivery of your last child?''

The most common types of discharge are serous and bloody. A serous discharge is thin and watery and may appear as a yellowish stain on the patient's garments. This commonly results from an intraductal papilloma in one of the large subareolar ducts. Women taking oral contraceptives may complain of bilateral serous discharge. A serous discharge can also occur in women with breast carcinoma.

A bloody discharge is associated with an intraductal papilloma, which is common among pregnant and menstruating women. It may, however, be associated with a malignant intraductal papillary carcinoma. The presence of any nipple discharge is more important than its character because both types of discharge are associated with benign or malignant disease.

A milky discharge is usually milk. It is common for women to continue to secrete milk for a few months after they stop nursing. In rare instances, the secretion may continue for a year. Persistent lactation, also known as galactorrhea, can be a result of massive hemorrhage occurring during childbirth and producing pituitary necrosis. Abnormal lactation may also result from a pituitary tumor that interferes with the normal hypothalamic-pituitary feedback loop or from the use of certain tranquilizing medications. Mechanical stimulation or suckling may produce physiologic stimulation.

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