Bloody nipple discharge during pregnancy: A rationale for conservative treatment

Abstract

Five cases of bloody nipple discharge during pregnancy without associated breast masses were seen over the past 3 years by the author. Because of the reported association of breast cancer with bloody nipple discharge, close follow-up of these women at monthly intervals during pregnancy and trimonthly during the postpartum period was carried out. In all instances, the discharge appeared late during the second trimester or during the third trimester of pregnancy. It was unilateral and spontaneous and arose from multiple ducts, and it was associated with an increase in breast size and always with the larger breast of the two. The discharge cytologic study done on all cases was negative for neoplastic cells and the discharges resolved spontaneously within 2 months of onset. Postpartum follow-up ranging from 6 months to 3 years has revealed no evidence of neoplastic changes thus far. Mammograms ordered before these patients were referred were not helpful due to the increase in density of the breast tissue secondary to the pregnancy. Because a few cases of breast cancer during pregnancy have presented solely with a bloody nipple discharge, I recommend extremely close follow-up of these women and no surgical intervention unless a mass is discovered or the nipple discharge cytology is either suspicious or positive at the initial visit or during follow-up.

Radiologic Evaluation of Breast Disorders Related to Pregnancy and Lactation

“…It usually appears in the 3rd trimester of pregnancy, when the vascularity of the breast is significantly increased and changes in the epithelium are more marked, resulting in bleeding, probably related to minimal, often unnoticed, trauma. Not surprisingly, therefore, occult blood has been demonstrated in up to 20% of women with nonhematic nipple discharge during pregnancy and in 15% of lactating women (32,33). This phenomenon usually ceases with the onset of nursing but in severe cases can continue for awhile during lactation.…”

Breast diseases during pregnancy and lactation

“…However, it can be cause by even small stimuli because the blood flow in breast increases rapidly and the change of epithelial cells gets even worst in 3rd trimester of pregnancy. Slight bloody nipple discharge can be seen from approximately 20% of nipple discharge during pregnancy and 15% of a period of lactation [26]. This phenomenon mostly stops as the lactate feeding begins, but also has a possibility of a severe case that may persist throughout the whole lactation period.…”

“…However, it is important to help the patient to be relieved because this kind of bloody discharge is a rare symptom of PABC (Figs. 6, 7) [26-28]. …”

Attitudes of NICU professionals regarding feeding blood-tinged colostrum or milk

“…14- 18 The cause of this condition is speculated to be intraductal bleeding on the basis of rapidly developing and easily traumatized mammary alveoli. The condition is said to be more common in first-time mothers and sometimes induced or exacerbated by nipple exercises (as with inverted nipples).…”

“…Lafreniere estimated that 15% of lactating women have blood in their early secretions. 18 On-line advice to mothers expressing blood-tinged milk ranges from abandoning breast feeding 14 to continuing breast feeding with the assurance that the blood will not harm her baby. 15,16 A similarly wide range of responses can be heard when blood-tinged colostrum or milk is brought to the NICU by mothers for feeding their ill neonate.…”