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Nipple Changes or Discharge and Breast Cancer

 

Pink Ribbon - Breast Reconstruction - Breast Cancer

 

Nipple discharge is the third most common breast complaint for which women seek medical attention, after lumps and pain in the breast. Any kind of discharge that occurs out of the nipple in a non-lactating woman is considered "nipple discharge". This non-milk discharge is excreted through the same nipple opening that can carry breast milk. Rarely, is nipple discharge a sign of breast cancer, however; it could be a sign of another condition that needs to be addressed.

 

Patients who are still menstruating and still has some discharge, normally this will resolve itself.  However, patients who are post-menopausal and experience discharge at any time - need to be seen by a physician immediately.

 

Suspicious nipple discharge is due to cancer in about 10% of cases. Most of the time, nipple discharge is caused by a benign condition called papilloma. This occurs in 50% of the cases and the other half consists of other benign conditions such as fibrocystic conditions (lumpy breast), duct ectasia (widening and hardening of the duct due to age or damage).

 

 

 

 

Nipple Discharge can be a concern if the following:

  • bloody or water fluid with a red, pink or brown coloration

  • sticky and clear in color - or brown to black in color (opalescent)

  • appears without stimulation to the breast

  • occurs persistently

  • happens on one side

  • fluid other than breast milk

 

 

 

                                    Common causes of abnormal nipple discharge

                                                  

                                      Copyright 2010 ADAM, Inc. - Used with permission

 

 

 

 


 

Benign Conditions that can cause Nipple Discharge:

This is a benign condition that is a tiny wart like growth in breast tissue that sometimes punctures a duct. These benign tumors are composed of fibrous tissue and blood vessels. Intra-ductal papillomas grow inside the breast milk ducts and can cause benign nipple discharge.

Intra-ductal papilloma, if they are located near the nipple area, can feel like a small lump.  Intra-ductal papillomas can be surgically removed if they are bothering the patient. A small incision is made along the edge of the areola, then the papilloma and its duct are removed. The resulting scar can be nearly undetectable.

 

Treatment:  Papilloma can be surgically excised if bothersome to the patient

 

 

 

Intraductal Papilloma

                                     Copyright 2010 ADAM, Inc. - Used with permission
 

        
 

                                                                                   

Mastis is a benign breast condition that happens normally when a woman is breastfeeding.  This is a non-cancerous condition. It is caused by a milk duct that has become clogged -  thus building up milk behind the duct, which will cause pressure and swelling. This can lead to infection, as bacteria can grow in the excess milk that has become trapped. Breast night become tender or lumpy and you might see some discharge from your nipple (which could be pus).

Bacteria (staphylococcus aureus) which does live on our skin, enters through an opening such as a dry cracked nipple. 

Women who are not breastfeeding and may be post-menopausal can also develop chronic mastitis.

Treatment:  Your physician will normally prescribe antibiotics to help get rid of the infection.

 

                           Mastitis of the Breast

                                          Copyright 2010 ADAM, Inc. - Used with permission                             

                                                     Mastitis of the Breast

 

 

 

A breast abscess - especially one that would occur under the nipple/areola complex can definitely cause discharge. This could possibly mean that a bacterial infection is occurring. 

Treatment:  Antibiotics are prescribed most of the time.

 

 

 

 

Sometimes an infection can cause nipple discharge. Depending on the circumstances of what possibly could be causing your infection, our physician may want take a sample of the discharge fluid and send it to a lab. 

Treatment:  If an infection is found, you may need to take antibiotics to clear it up.  Taking your temperature periodically is important. 

 

 

 

 

Fibrocystic breast disease is a very common and a noncancerous (benign) breast condition. There is also no increased risk factors with fibrocystic breasts.

Fibrocystic breasts:
  • nodular breast tissue (fibrous tissue)

  • glandular tissue

  • enlarged lobules

  • fluid filled cysts

  • tissue feels lumpy or full of bumps in texture (areas of thickening)

  • overgrowth of cells in the lining of the milk ducts

  • fluctuating size of breast lumps

  • non-bloody discharge from the nipples

  • pain and tenderness is associated with this (especially before a woman's ovulation cycle)

  • occurs in women aged 20 - 50 - rarely in postmenopausal women

Most physicians do not call fibrocystic breasts a "disease state" anymore, as it is so common and most women at one time or another in their lives might experience this. 

Treatment:  There is no real medical treatment for fibrocystic breast - however; a patient should take extra pre-caution when doing breast self exams to make sure there are no changes with lumps.  Limiting your intake of caffeine is standard protocol by most physicians.   Fortunately, most of the symptoms of fibrocystic breast goes away after a woman is in menopause.

 

                                    Fibrocystic Breast

                                       Copyright 2010 ADAM, Inc. - Used with permission

                                                          Fibrocystic Breast

 

 

 

Fibro-adenomas are benign breast tumors (not cancerous) that are made of glandular and fibrous breast tissue. These can be clearly seen on a mammogram - alone, groups or as complex.  If the mammogram shows you have multiple or complex fibro-adenomas - this can raise the chance of breast cancer slightly.

Symptoms of Fibro-adenomas

  • firm, round, smooth, rubbery or moveable lumps

  • clearly defined and not blurry on the mammogram

  • calcifications can occur next to these masses

  • look like a cyst or a well contained tumor

  • tender to the touch

  • swelling can occur due to hormonal changes

  • discharge from the nipple area

  • range in size from 1 to 5 cm.

Treatment:  Normally a biopsy is the most definite way of achieving a diagnosis.  Sometimes these lumps can go away on their own.

The following tests and treatments are recommended:

 

 

                                    Fibroadenoma of the breast

 

                                       Copyright 2010 ADAM, Inc. - Used with permission

 

 

 

Mammary duct ectasia occurs when a milk duct beneath your nipple becomes blocked or clogged.  This occurs most often in women between the ages of 40 to 50 - and normally seems to happen in post-menopausal women.

For the most part, mammary duct ectasia doesn't cause signs or symptoms - however some women might experience the following: 

  • A white, green or black tint nipple discharge

  • Nipple discharge from one or both nipples

  • Tenderness in the nipple or surrounding breast tissue

  • Redness

  • A lump or thickening

  • An inverted nipple

Treatment:  Mammary duct ectasia normally improves on its own, however; sometimes antibiotics are needed or possibly surgery to the affected milk duct.

 

                                          Mammary Duct Ectastia

                                      Copyright 2010 MAYO CLINIC - Used with permission               

                                                      Mammary Duct Ectastia

 

 

 

Excessive breast stimulation, medication side effects, or disorders of the hypothalamus or pituitary glands all may contribute to galactorrhea. Increased levels of prolactin, the hormone that stimulates milk production can also contribute to galactorrhea. 

Read more about Galactorrhea

 

 

 

 

If breast stimulation causes some nipple discharge from multiple ducts, normally there should be no sign for concern. This discharge does not point to breast cancer - but seeing a physician is important for an evaluation. 

Bloody or clear, spontaneous and persistent nipple discharge from one duct requires urgent medical evaluation, as it may be a sign of an underlying breast cancer.

Excessive breast stimulation include:

  • associated with sexual activity

  • frequent breast self-exams

  • prolonged clothing friction

 

 

 

 

Medications can cause nipple discharge occasionally:
  • tranquilizers

  • anti-depressants

  • high blood pressure drugs

  • birth control pills

  • hormone replacement pills

  • herbal supplements, such as fennel, anise or fenugreek seed

 

 

 

 

The following hormone imbalances can cause benign nipple discharge:

  • A non-cancerous pituitary tumor (prolactinoma) or other disorder of the pituitary gland

  • An under-active thyroid (hypothyroidism)

  • Chronic kidney disease

 

 

 

 

 

The following situations can cause benign nipple discharge:

  • Nerve damage to the chest wall from chest surgery, burns or other chest injuries

  • Breast augmentation, breast lift or breast reduction

  • Spinal cord injury

 

 

 

 

Prolactinoma is a condition in which a tumor (adenoma) of the pituitary gland in your brain overproduces the hormone prolactin. These tumors are considered non-cancerous. 

The major symptoms of prolactinoma:

  • increased prolactin - which will cause normal levels of sex hormones to decrease

  • visual impairment

  • infertility

  • irregular or lack of menstrual periods

  • milky discharge from the nipple

  • vaginal dryness

  • low bone density

Treatment:  medications are used to restore the prolactin level to normal. Surgery to remove the pituitary tumor also may be an option.

 

 

 

 

 

The milky discharge a woman will experience during pregnancy is called colostrum and is perfectly normal. Not all pregnant women will experience this however. If this should happen, it normally starts around the mid trimester until the time she will deliver the baby. The breasts are preparing for breastfeeding. If there is a lack of colostrum, this does not mean that the woman will not be able to breastfeed successfully.

 

 

 

 

 

 

More Breast Reconstruction and Breast Cancer Information:

 

 

 

 

 

  

   

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