Management of nipple discharge

Abstract

In a series of 8,703 breast operations, nipple discharge was the presenting symptom in 7.4% of cases. It is even more common in the office and clinic since many discharges can be treated medically. To be significant, a discharge should be true, spontaneous, persistent, and nonlactational. Of the 7 basic types, i.e., milky, multicolored and sticky, purulent, clear (watery), yellow (serous), pink (serosanguineous), and bloody (sanguineous), the last 4 are the surgically significant ones. Of the 586 patients operated on for one of these types of discharge, the majority had a benign etiology, i.e., intraductal papillomata (48.1%) and fibrocystic changes (32.9%), but 14.3% were due to cancer and another 7.3% to precancerous mastopathy. In the 84 patients with cancers, the false-negative rate for mammography was 9.5% and was 17.8% for cytology. There was no palpable mass in 13.1% of patients. There was an increasing likelihood of the discharge being due to cancer when the discharge was, in order of increasing frequency, yellow, pink, bloody, or watery, when it was accompanied by a lump, when it was unilateral and from a single duct, when the mammogram or galactogram and the cytology were positive, and when the patient was over 50 years of age. Milky discharges are usually treated medically unless they are due to a pituitary adenoma. If the cause cannot be found and eradicated, bromocriptine is the drug of choice. Multicolored sticky discharges are also treated medically, chiefly by nipple hygiene, except when advanced. Purulent discharges are treated with appropriate antibiotics but abscesses need drainage and a biopsy of the wall. Except in women under 35 years of age or in those anxious to have children, surgically significant discharges are treated by central duct excision. Good cosmetic results can be obtained with careful technique and the danger of a recurrent discharge is eliminated.

Galactography in Patients with Nipple Discharge

“…Solitary or multiple papillomas are the most common cause of nipple discharge reported (35%-62%) (1,4,5,9,(16)(17)(18)(19); in our study, they accounted for 74% of the cases. Papillomas, although benign, are associated with a 5% risk of developing into invasive carcinoma (20).…”

“…Abnormal nipple discharge is associated with an underlying malignancy in 1.2% to 15% of patients (1)(2)(3)(4)(5). Abnormal discharge is defined as nonlactational, persistent, spontaneous, and unilateral (6).…”

“…Characteristics of a benign source include a milky, bilateral discharge, which does not require further follow-up. The discharge is due to an underlying malignant lesion, however, in up to 15% of cases (1)(2)(3)(4)(5). Discharge from a malignant source is spontaneous, unilateral, persistent, and nonlactational (6).…”

“…These include the infrequent identification of a mass lesion on examination and the occasional abnormal mammogram. Cytology of the discharge itself is often unrevealing and is not helpful in localizing a tumor (1,5). Galactography (ductography) is often used to localize and characterize ductal abnormalities.…”

Duct Ectasia and Periductal Mastitis in Indian Women

“…Nipple discharge accounts for 5 to 10 % of all the breast problems [1][2][3]. Although 95 % of nipple discharge is related to benign condition [2,4], it alarms the ladies who develop a fear of cancer.…”