Nipple discharge is a fairly common condition appearing in about one third of all women. This article by an expert breast surgeon explains what signs and symptoms may indicate a more serious disease such as breast cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body..
Nipple discharge is the production of fluid from the nipple. The fluid comes from the milk glandAn organ with the ability to make and secrete certain fluids. ducts that open at the nipple. Although the average number of milk ducts opening on the surface of the nipple is 27, only five of these ducts are functional.
Most cases of nipple discharge are due to normal, benignNot dangerous, usually applied to a tumour that is not malignant. conditions and are usually hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect.-related. Approximately one third of all women can produce a nipple discharge by gently massaging their breasts. This 'innocent' nipple discharge usually comes from multiple ducts in both breasts in pre-menopausalRelating to the menopause, the time of a woman’s life when her ovaries stop releasing an egg (ovum) on a monthly cycle. women. Blood-stained discharge from a single duct in one breast can be sinister in nature and may represent an underlying carcinomaA malignant tumour (cancer) that is formed from the epithelium, the tissue that covers the open surfaces of organs..
Women with nipple discharge should consult their GP without delay. They may then be referred to a breast specialist who will examine the breasts in more detail.
Depending on the number of discharging ducts and the colour of the discharge produced, the specialist may arrange further investigations including microscopic examination of the discharge fluid, an ultrasound scanThe process of using high-frequency sound waves to produce internal images of the body. (if the patient is younger than 35 years) and/or a mammogramAn imaging study of the breasts, for example, by X-ray. (if the patient is older than 35 years). Occasionally a breast lump is found in a patient presenting with nipple discharge. Such lumps are investigated appropriately.
If the microscopic examination and mammographyA diagnostic and screening test using low-dose X-rays to detect breast tumours/ultrasoundA diagnostic method in which very high frequency sound waves are passed into the body and the reflective echoes analysed to build a picture of the internal organs – or of the foetus in the uterus. show no worrying features, the patient can be reassured. Women who have bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid.-stained discharge coming from a single milk gland duct, and show abnormalities on microscopic examination, will require surgical excisionThe removal of a piece of tissue or an organ from the body. of the discharging duct. The operation to remove a single duct is known as a microdochectomy and is usually performed as a day-case procedure. The removed tissueA group of cells with a similar structure and a specialised function. is sent to the pathology laboratory for further examination. In some centres it is also possible to carry out a camera examination of the nipple duct, which is called mammary ductoscopy. I introduced this new technology to the UK 10 years ago. Figures 1 and 2 show the endoscopyExamination of the inside of the body using a tube equipped with a light source and either a small camera or an optical system. of a normal milk duct and one exhibiting early breast cancer resulting in nipple discharge.
Clear discharge arising from multiple milk gland ducts is usually normal. It does not require treatment unless it becomes troublesome or associated with abnormal microscopy or mammography, when surgery may be considered. The operation consists of the total removal of all the ducts draining into the nipple. The main risks of the procedure include the death of the nipple tissue (uncommon) and the reduced sensitivity of the nipple area (one third of cases). Such complications should be weighed against the severity and inconvenience of the symptoms.
Milky discharge through the nipple, called galactorrhoeaDischarge of milk from the breast other than during lactation, is normal during and within two years after pregnancythe period from conception to birth. Milky discharge occurring outside pregnancy can be caused by an imbalance of the hormone prolactinA hormone produced by the pituitary gland in the brain that stimulates breast growth and milk production. Both men and women produce some prolactin, but levels increase in women during pregnancy and breastfeeding, which controls milk production. A small gland in the brain, called the pituitaryA gland deep in the brain that produces several hormones controlling the production of other hormones throughout the body gland, produces prolactin. Tumours arising in this gland may cause excessive amounts of prolactin to be released into the bloodstream, thus stimulating the breast tissue to release a milky discharge. A brain scan may be required to look for tumours in the pituitary gland. Pituitary tumours are usually benign and are easily treated with drugs or through surgery. If prolactin levels are within normal limits, the patient can be reassured that the discharge is likely to improve without further intervention.
Click on the link below for images of breast ductoscopy under local anaesthesia (as performed by Prof Kefah Mokbel).