nipple discharge

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Introduction

Only spontaneous discharge as distinguished from non-spontaneous discharge or discharge requiring manipulation to elicit is clinically significant.

Nipple discharge in men or bloody discharge is cancer until proven otherwise.

Bilateral nippledischarge is generally endocrine or secondary to pharmacologic agents (see galactorrhea).

Unilateral discharge should increase clinical suspicion of malignancy.

purulent discharge
- generally occurs during pregnancy or lactation
- fever
- erythema
- fluctuance
- purulent discharge
non-bloody discharge
- green, brown or yellow heme-negative discharge
- may occur in associated with breast manipulation
- may occur in relationship to menses
bloody discharge
- sanguineous, serosanguineous or clear heme-positive discharge from nipple

non-bloody discharge
- mammogram in women over 30 or strong history of breast cancer
- galactogram not useful

purulent discharge
- 2nd generation penicillin
- incision & drainage of abscess
non-bloody discharge
- decrease manipulation of breasts
- surgery referral
  - findings on palpation
  - positive mammogram
  - findings on cytology of fluid
  - discharge persistent & interferes with patient's life
bloody discharge
- excisional biopsy of any mass
- excision of offending duct for histopathology if no mass is found
- monthly breast exam for one year
- mammograms every 6 months for 1 year

↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 384