Nipple discharge

Discharge that occurs only when the nipple is squeezed, in the absence of any other symptoms, should be brought to your doctor's attention for a check-up. In most common cases, it is probably not a cause for grave concern.

Any milky discharge that occurs during late pregnancy and obviously after delivery, is generally not of concern.

Nipple discharge is more worrisome where the discharge occurs in combination with a lump, when it occurs without any stimulation, pressure or squeezing (called 'spontaneous discharge'), or when the discharge is bloody or blood-stained.

Fortunately most women with nipple discharge do not have cancer however it should always be assessed by your doctor, especially if any of these more concerning associated features is present.

Some possible non-cancerous conditions that may present with the symptom of nipple discharge include:

1. Intraductal papilloma, is where there is a benign growth in one of the mammary ducts near the nipple. Sixty to eighty per cent are accompanied by a spontaneous or induced bloody, serous (clearer but not colourless), aqueous (watery) or serobloody (a bit bloody but not completely) nipple discharge. This benign growth is associated with a 5 per cent increased risk of subsequent development of invasive breast cancer. In some cases there may be multiple papillomas, a condition known as papillomatosis, affecting one or both breasts. Once the diagnosis has been confirmed by the breast specialist (usually involving ductography where contrast dye is injected to identify filling defects or interruption in flow of contrast in the duct or ducts where the papilloma or papillomas are present, and confirmed by biopsy and pathological examination of the cells involved) surgery is required to remove the affected area.

2. Duct ectasia, which is estimated to be responsible for anything from 20 to 50 per cent of nipple discharges. Duct ectasia is an inflammatory process, usually affecting women in their late forties or early fifties, as they approach menopause. Here, the mammary ducts located under the nipple become dilated or widened which can lead to blockages. As a result, fluid can pool and leak into the surrounding tissue causing infection, chronic inflammation or abscesses. This can result in the formation of scar tissue which may in turn cause nipple retraction. Infection may result in breast pain and a thick sticky nipple discharge. Fortunately duct ectasia is a benign (non-cancerous) condition and surgery, while sometimes required to remove the affected breast duct, is not necessarily needed. Depending on the individual, warm compresses and antibiotics may suffice. Your doctor and breast specialist will advise your treatment and management options and guide you through the pros and cons.