Nipple Problems and Discharge
What are some common nipple problems?
Nipple conditions are a common benign (noncancerous) breast condition affecting many women. Some problems are related to lactation. Others are not. Like all breast conditions, any nipple problems should be reported to your healthcare provider for a prompt diagnosis and treatment.
What is ectasia?
As a woman approaches menopause (around her late 40s, early 50s), the mammary ducts—located under the nipple—become dilated (widened). This normal process of dilation of the milk gland is called ectasia.
Ectasia is a benign (noncancerous) breast condition. In some cases, ectasia can lead to a blockage of the ducts. As a result, fluid may become pooled and leak into the surrounding tissue causing infection, chronic inflammation, or abscesses. If an infection (also referred to as periductal mastitis) happens, it may cause scar tissue to develop, thus drawing the nipple inward. In addition, this infection may cause breast pain and thick, sticky nipple discharge.
Treatment for ectasia
Specific treatment for ectasia will be determined by your healthcare provider based on:
Your age, overall health, and medical history
Extent of the condition
Your tolerance for specific medicines, procedures, or therapies
Expectations for the course of the condition
Your opinion or preference
Treatment for ectasia generally involves treating the symptoms. This may include warm compresses and/or antibiotics. In some cases, surgery is required to remove the affected breast duct(s).
What is intraductal papilloma?
An intraductal papilloma is a small, wart-like growth that projects into the breast ducts near the nipple. This causes a bloody or sticky discharge. In addition, any slight bump or bruise near the nipple can cause the papilloma to bleed. If the discharge becomes bothersome, the duct can be surgically removed. This can often be done without changing the appearance of the breast.
While single papillomas most often affect women nearing menopause, multiple intraductal papillomas are more common in younger women. They often happen in both breasts. Multiple intraductal papillomas are more likely to be associated with a lump than with nipple discharge. Any papilloma associated with a lump is surgically removed.
What about other types of nipple discharge?
While nipple discharge can be alarming to many women, discharge that appears only when the nipple and breast are squeezed may not be a cause for concern. The risk of cancer when nipple discharge is the only symptom is relatively low.
If there is a lump with the discharge, this will be of primary concern to your healthcare provider. Keep in mind, however, that in breastfeeding women, lactational mastitis complicated by an abscess can often cause a lump beneath the areola, as well as a discharge.
A milky discharge from both nipples, when it is not related to breastfeeding, is called galactorrhea. This is usually due to an increase in the hormone prolactin, which produces milk. Galactorrhea may be caused by tranquilizers, marijuana, or high doses of estrogen. It is often accompanied by an absence of menstrual periods.
Nipple discharges that are a result of a benign breast condition may be treated by keeping the nipple clean, among other treatments. Nipple discharges that are a result of infections may require hospitalization.
How is nipple discharge diagnosed?
Your healthcare provider will, most likely, want to determine if the discharge is coming from 1 duct or several. Multiple duct discharge is nearly always benign and is likely due to changes like ectasia. When the discharge is coming from a single duct, this may be more significant. However, if mammography shows no abnormality, surgery may not be necessary.
Nipple discharge may be a variety of colors and textures. Your healthcare provider may take a sample of the discharge and have it analyzed in a lab to confirm a diagnosis.
- Foster, Sara, RN, MPH
- Horowitz, Diane, MD