Nipple Discharge: Causes and Recommendations

Nipple discharge is a frequent reason for gynecological consultation. Thus, establishing its cause is fundamental to reduce the risks of major diseases. Find out more about it in this article.
Nipple Discharge: Causes and Recommendations

Last update: 19 January, 2021

Nipple discharge can be a rather uncomfortable condition, but every case has a cause. It could be anything from breast dysplasia to cancer, but the latter only happens in a few cases.

In medical terms, this condition is known as “telorrhea,” which refers to any breast discharge outside of pregnancy or breastfeeding. “Galactorrhea,” a similar term, refers to the production of milk and it’s usually due to hormonal causes.

Continue reading to find out more about it.

Are there other symptoms besides nipple discharge?

The fluid usually secretes from the nipple through tiny holes located in the areola. The nature of this substance depends on its physical characteristics and varies, it could be:

  • Whitish or milky
  • Serous, pale, or slightly yellowish
  • Reddish
  • Any combinations of the above

There may be a constant pain or pain only during the production of liquid, depending on the cause. It’s also possible to detect a mass or nodule with diverse characteristics (size, location, mobility and build).

The discharge is unilateral (affecting only one breast) in most cases, but can be bilateral when there are hormonal problems. There may also be nipple retraction or skin redness, suggesting underlying inflammation.

A woman evaluating her breast.
Nipple discharge may manifest along with other symptoms such as pain, swelling, and breast lumps.

Reasons why nipple discharge may occur

There are many causes for this kind of symptom. For example, these could originate in the breast (such as infections or cancer) or extramammary (brain tumors or drug intake).

Most frequent causes for nipple discharge

Let’s review localized infections in the breast, including intake of psychopharmaceuticals, intraductal papilloma, and fibrocystic breast condition.

1. Localized infections in the breast

Mastitis or breast abscesses are frequent causes of nipple secretion. They happen after the opening of a duct that allows their content to come out. In this case, the secretion is purulent and has a bad smell and there’s pain upon palpation, enlargement, and redness.

This is much more frequent during breastfeeding (due to the baby’s manipulation of the nipple) but it can also happen at any time.

2. Psychopharmaceutical intake

Prolactin is a hormone responsible for stimulating the production and secretion of breast milk. In turn, this is regulated in the brain by a neurotransmitter known as dopamine.

Treatment with some drugs that have a direct effect on the central nervous system can involve changing the body’s dopamine levels, which also affects the production of prolactin and breast milk.

Also, drugs such as phenothiazines, some antidepressants, and anxiolytics can cause the secretion of milk outside the breastfeeding stage.

3. Intraductal papilloma

This is usually a benign condition although it usually gets attention due to its characteristics. In fact, several complementary studies are required if it’s present.

The secretion in this disease is usually spontaneous and often occurs in premenopausal patients. Like in the previous example, this disease originates in the lactiferous duct.

There’s a proliferation of cells that eventually leads to the formation of a small mass capable of producing serous secretion with some blood (serohematic).

4. Nipple discharge could be due to a fibrocystic condition of the breast

This condition is also known as “mammary dysplasia.”Furthermore, it’s one of the most frequent benign breast conditions, according to several epidemiological studies. It consists of the proliferation of “support tissue” (connective tissue) that can still occur during a woman’s reproductive stage.

This leads to the formation of moderate size masses which can be painful and produce a whitish secretion through multiple orifices. In general, it affects both sides and is one of the most frequent reasons for consultation in gynecology.

Depending on the age of the patient, the physician will require studies such as mammography to determine the probability of a malignant lesion. However, this happens on rare occasions.

Least frequent causes

This group includes some conditions such as galactophorous, pituitary tumors, duct ectasia, and breast cancer.

1. Galactophoritis

The breasts contain structures called lactiferous ducts, which can sometimes become inflamed. These are in charge of transporting the substances produced in the mammary glands to pour them out.

This is usually a chronic inflammation (it takes a long time to evolve) and, also, there’s no well-defined cause yet. We do know it can be both infectious and non-infectious.

2. Pituitary tumors

Prolactinoma is one of the most striking examples of a pituitary tumor and is one of the most common causes of nipple discharge due to a tumor. Also, the origin is extramammary, which means it’s located in the pituitary gland and can produce prolactin.

As we mentioned above, this hormone is responsible for stimulating the production of breast milk. Thus, specialized studies such as cerebral magnetic resonance are required for the diagnosis of this condition.

3. Ductal ecstasy

The term “ectasia” refers to the dilation of the ducts closest to the nipple in this case. It usually produces a discharge with a variety of colors that range from yellow to brown.

It can affect both breasts and is a benign condition since so far there’s no evidence to suggest malignancy when left untreated. However, a physician must always confirm this.

4. Breast cancer

This cause is one of the least frequent. In fact, in very few cases does the secretion from the nipple has a malignant origin. Breast cancer usually occurs silently, which is why it is usually detected in the late stages.

There may be nipple retraction and the presence of a nearby mass when this happens, which is hard and not always painful. The doctor will indicate the corresponding tests for diagnosis, such as mammography.

When to see a doctor

We suggest that you plan to see your gynecologist or family doctor as soon as possible if you have any of the symptoms mentioned above.

These types of problems have a benign origin and some cases don’t require treatment. However, consult a doctor to find out for sure if the secretion may be the result of malignant disease.

Men can also present telorrhea and develop breast cancer. They should go to the doctor as soon as possible.

A doctor talking to a patient.
Consult a doctor in the presence of nipple secretion, they should be able to conduct any pertinent tests according to the case.

Treatment of nipple discharge

How doctors treat this condition depends entirely on the cause of the discharge. In fact, some cases may not require therapeutic measures unless it represents considerable discomfort to a person.

Treatment may include surgical resolution, the removal of the mass involved in cases where there’s a proliferation of tumor tissue (papillomas, prolactinomas, and cancer).

Regulating the dose or changing the treatment is the only solution in those conditions developed by drug intake. Finally, infectious diseases may require surgical drainage (as is the case of abscesses) and administration of antibiotics for a few days.

Consulting a doctor will help prevent complications

Nipple discharge is a common problem and its causes are many and diverse, as are the therapeutic options. Always consult a doctor for proper evaluation of any type of symptom.

While not all visits should be treated as emergencies, it’s preferable to plan an appointment as soon as possible to be at peace. This is because seemingly insignificant symptoms could mask serious conditions.

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