Breast Nipple Discharge
Frederick R. Jelovsek MD
- Dark green nipple discharge - mammary duct ectasia
- Nipple discharge and elevated prolactin level
- Nipple itching and amber fluid discharge
- Clear discharge; green discharge
- Whitish--yellow discharge from nipples
- Bloody discharge from nipple
- Reddish-brown discharge from nipple
- Expressing fluid from nipples
I am 28 with fibrocystic breasts. For the past week my left breast has oozed dark green fluid but I do not have the usual swelling or pain. Could this be cancer? My doctor has ordered a mammogram.
The discharge may be due to the fibrocystic disease. However, such greenish discharge is also characteristic for an inflammation of the breast ducts called mammary duct ectasia which is not usually related to an underlying cancer nor does it put you at greater risk than the normal for breast cancer. Ectasia is an inflammation of the breast ducts that is not caused by bacteria. While it is usually a benign process, it can sometimes look like a cancer on a mammogram and thus will most likely require a biopsy. Also, surgery may be indicated if there is a very persistent, copious discharge, breast pain, nipple retraction or an underlying mass thought to be an abscess or inflammatory mastitis. It is difficult to treat and excision of the inflamed ducts is only about 85% successful. Whether the mammogram is benign or not, you should see a surgeon experienced in breast disease for further management.
Periductal mastitis masquerading as carcinoma.
Miller SD, McCollough ML, DeNapoli T,
Department of Dermatology, Brooke Army Medical Center, Fort Sam Houston, TX 78234-6200, USA.
Dermatol Surg 1998 Mar;24(3):383-5,
Periductal mastitis (mammary duct ectasia) is a little appreciated, often unrecognized entity that may present to the dermatologist. We present our experience with this disease and hope to familiarize the reader with a condition not well known to most dermatologists. Periductal mastitis is a benign mammary duct disease that begins with periductal inflammation and progresses to ductal dilatation with minimal inflammation (ductal ectasia). The clinical and radiographic appearance of this disease can be indistinguishable from carcinoma of the breast.
[The duct ectasia syndrome--an overlooked disease entity]. [Article in Danish]
Petersen L, Graversen HP, Andersen JA, Dyreborg U, Blichert-Toft M, Odense Sygenhus, Kirurgisk afdeling K.
Ugeskr Laeger 1993 May 17;155(20):1540-5.
Mammary duct ectasia is a benign disease of the mammary gland, characterized by a frequently long history of tumour formation, nipple discharge, nipple retraction and mastalgia. Non-puerperal mammary abscess, which may be the presenting symptom, is also part of the syndrome. Diagnosis can often be made on the basis of the history and the clinical findings of nipple discharge, nipple retraction, tenderness on palpation, fistula formation and suareolar (sub?) tumour/abscess formation. Mammography may guide diagnosis. Breast cancer is the most important differential diagnosis. If the clinical picture resembles cancer, it is necessary to perform diagnostic biopsy. Causal therapy of mammary duct ectasia is not available. Until now excision of the central mammary tissue and larger ducts has been used as treatment for the clinical manifestations of abscess, fistula and nipple discharge, apparently with good results.
Excision of the major duct system of the breast for symptoms owing to mammary duct ectasia may be curative, but recent reports have been less optimistic. A retrospective study (1978-1990) of 46 women (median age 38 years, range 18-78 years) who underwent subareolar dissection with antibiotic cover for symptoms associated with duct ectasia is presented. Thirty-three women presented without symptoms of overt sepsis (periareolar lump, nipple discharge or nipple retraction). Following subareolar dissection, six developed recurrent symptoms and five required further surgery. Thirteen women presented initially with abscesses. Eight abscesses recurred following incision and drainage, and one developed a mammillary fistula. Following subareolar dissection, six developed recurrent sepsis requiring further surgery.
My troubles started last year when I had breast discharge at the same time that I missed two monthly periods in a row. I had never missed a period ever and have always been regular as clock-work, give or take a period or two when I was late/early by a week or so. Pregnancy tests were negative and my first prolactin level was 130, next was 110, next was 170. My doctor said I had a prolactinoma but not to worry because it was benign. I also had a CAT scan which was reported to be negative. I was referred to an endocrine doctor who repeated the same blood work. The endocrine doctor did not give a diagnosis of any sort, but did prescribe Parlodel which I am now taking. After six weeks of Parlodel the breast discharge has stopped, my prolactin level last tested at 26, and I have no side effects other than the initial dizziness. However, I have never had an official diagnosis. When I asked my doctor, she said I should never rule out the possibility of a prolactinoma. What does this mean? Do I have a prolactinoma or just hyperprolactinemia or are they the same? Also, there is a history of thyroid disease on my mother's side. Every single female has some sort of thyroid problem, low/high/goiter or menstrual problem. I am the only one who tests normal for thyroid function and has normal periods. Is it possible that my high prolactin levels are really thyroid-related even if my thyroid test is normal?
A diagnosis of prolactinoma is made by the presence of two factors - 1) elevated prolactin levels and 2) the secreting tissue has to be big enough to enlarge an area in the brain, the sella turcica. Since they did not see that enlarged area on the CAT scan, they could not "officially" diagnose a prolactinoma. However, because the prolactin level was so high, they are treating you under the assumption that there is "hyperplasia" of prolactin secreting cells even though that area is not big enough to enlarge the sella. In view of your normal thyroid tests, your elevated prolactin levels and missed periods are probably not related to any thyroid disfunction.
I am a 63 year old woman. For the last couple of years I have had a clear, amber colored fluid coming from my right breast. The doctors tell me just to do regular self breast exams, to have regular mammograms, and to come into the office right away if there is any change. However, the thing that no one seems to hear it is that my nipples itch so badly that it is driving me crazy and to the point of crying. I use Reactine, and Lanacane and Gold Bond Powder and anything else that I think might help. No one talks about this. Am I the only one in the world with this problem? Please help.
If the itching is only on the right breast, it may be related to the discharge and there may something in the duct such as a papilloma, adenosis or even an early cancer that just does not show on mammogram. You need to see a breast surgeon specialist to be checked for Paget's disease of the breast or an intraductal lesion. You may have to have special studies done to look inside the ducts of the nipples. This is especially true if the discharge comes from just one of the ducts in the nipple rather than all of them. The serous (amber) discharge from only one duct is almost always due to something specific in that duct rather than from general fibrocystic changes.
I am a 31 year old woman with fibrocystic breasts. I have never had children, but recently when squeezing my nipples on breast exam I discovered a discharge coming from both nipples. The discharge was white and cloudy but with a slight yellow/green color if put on white cloth. My doctor ran a blood test to check for a condition having to do with the pituitary gland. I received a letter in the mail stating that the blood test showed normal levels of prolactin indicating no pituitary tumor. The doctor told me that sometimes stress can cause women to lactate. I am concerned and want to know if this sounds feasible. It has been two weeks and I am still discharging upon squeezing my nipples. I am worried my doctor is being hasty at writing this off to stress. Please help.
As long as the doctor noted that the discharge was milky or looked at it with a stain under the microscope for fat globules, then it is a physiologic discharge which is like lactation. If there were fat globules, then the discharge is galactorrhea which is a hormonal, dysfunctional disorder that will worsen or persist with chronic nipple squeezing. I do not consider once a month squeezing for breast exam harmful with galactorrhea, but daily or every other day squeezing will likely make galactorrhea persist and worsen. If it is galactorrhea, since the blood test is normal, then nothing else needs to be done except as above with hands off.
If there were not fat globules on the microscopic exam, the discharge is likely due to the fibrocystic changes and you can squeeze to express the nipples all you want and it will not improve or worsen the discharge. You do, however, need to watch for any blood in the discharge or if it turns green and sticky from the nipple.
If the discharge without stimulation turns yellowish as it comes from the nipple or becomes greenish brown or black, then you need to be reexamined by a breast surgeon to be evaluated for mammary duct ectasia, papillomas or breast cancer. If work-ups for those are negative, then it can just be followed under the assumption it is due to "fibrocystic changes".
For the past couple of weeks I have had a clear fluid discharge from my left nipple. Then today I noticed a bit of bloody discharge which appeared to be coming from one just one duct on the left nipple. It was bright red. Is this serious or should I wait to see if it goes away?
You need to be seen by a breast surgeon/specialist. The bleeding may represent an intraductal papilloma, a cancer, or just fibrocystic changes. You will need a mammogram and possibly an intraductal dye injection. The observation that the blood is coming from just one duct is against fibrocystic change and is associated about 9 times out of 10 with a benign intraductal papilloma and about one time out of 10 with an intraductal carcinoma. Be sure to have it checked out. The odds are way in favor of being a benign process but even with the small chance of malignancy, if treated early it is entirely curable.
Nine months ago I saw my doctor because I expressed clear fluid from my right nipple during my monthly breast exam. The doctor tried to get a sample for the lab but got it all over fingers instead so he did blood tests for prolactin and thyroid function, both of which came out negative. I still have this clear discharge and my right breast keeps getting larger. Well, now my left breast has green discharge coming out of one area. What is going on?
A clear discharge is not worrisome and generally happens with fibrocystic disease. A greenish discharge, however, can represent an inflammation of the breast ducts called mammary duct ectasia. Ectasia is a benign condition but it is still a good idea to see a breast surgeon about it because occasionally some excision of the ducts needs to be done or there are coexistent breast cysts or abscesses that need to be removed. You need to have your doctor refer you to a surgeon in your area who does a lot of breast work.
My last period ended about 3 1/2 weeks ago. A week later I started to have breast pain again, and till now, it's still sore. Is it possible that I am pregnant even though I haven't missed a period? Over all the years, I realize that when I press my milk ducts, there is a white color discharge. Just a few days ago before the pain started, I cleared the white stuff from the breast by pressing them hard. I have been doing this about once a month however to clear the breasts and I haven't had the pain before. Could this have caused the pain?
It is possible that you caused the pain by pressing too hard, etc. "Clearing" the breasts shouldn't be necessary and probably leads to continuing discharge just as nursing after a pregnancy keeps sending a signal to keep producing milk.
It can be from an intraductal papilloma of the breast, fibrocystic breast changes, mammary duct ectasia or a cancer of the breast. Most of the time it turns out to be an intraductal papilloma but that news should not delay you from seeing a doctor. That needs to be diagnosed right away because if it is a cancer (about 10% chance) it would be an early one that could possibly be treated without radical surgery.