Nipple Discharge
Nipple discharge is a symptom that approximately 80% of women of reproductive age experience at certain periods of life and can be evaluated as normal or abnormal depending on the characteristics of the discharge. The discharge may be due to medications used by the person, infection, or cancer affecting the breast tissue, or it may be completely physiological and harmless. It is extremely important for all women of reproductive age to have information about nipple discharge, to be able to distinguish inflammation and similar infection signs at the tip of the breast, and to recognize possible cancer at an early stage.
The color of the discharge may be completely clear or transparent, or it may be dark yellow – gray, greenish, milky, inflammatory and cloudy. In middle-aged women, gray discharge may occur when the brown tip of the breast, called the areola, is squeezed, but nipple discharge removed by force is generally not considered pathological and does not indicate a disease. However, all discharge seen in the breast must be examined in detail and the underlying disease, if any, must be determined.
What Causes Breast Discharge?
In some cases, nipple discharge may occur due to a completely physiological and natural cause, or it may develop due to serious diseases such as mastitis, papilloma or cancer. In order to determine the main factor causing the discharge, it is necessary to review in detail many features such as the color of the discharge, its consistency, frequency, whether it is one-sided or not, whether it occurs with squeezing or spontaneously.
- Physiological nipple discharge is a completely natural process. It usually occurs during pregnancy and may recur intermittently for approximately 2 years after birth. Bloody nipple discharge may rarely occur in pregnant women and breastfeeding mothers. It is caused by excessive blood supply to the nipple and milk ducts due to pregnancy hormones. However, if this situation becomes persistent or recurs frequently, it must be evaluated by a breast surgeon.
- However, nipple discharge may not be caused by a pathological condition in the breast tissue, but by disorders in other organs of the body. Tumors affecting the area of the brain called the pituitary gland, hypothyroidism, which can be defined as less than normal functioning of the thyroid gland, cancers affecting the respiratory tract or lung tissue, and some disorders affecting the area of the brain called the hypothalamus, can cause nipple discharge.
- Some medications can cause spontaneous milk secretion from both breast tissues. spontaneously from both breasts due to the effects of antipsychotic group drugs used in the treatment of psychoses such as schizophrenia in psychiatry, stomach acid regulators called H2 receptor blockers, antihypertensives used in the treatment of high blood pressure, antiemetics used as nausea relievers, oral contraceptives used for birth control and drugs used in the treatment of some neurological diseases. Milky discharge may occur.
- Nipple discharge, which is grouped as pathological, may occur as a result of benign diseases such as intraductal papilloma, ductal hyperplasia, ductal ectasia, plasma cell mastitis and chronic mastitis, or it may be due to breast cancer. Intraductal papilloma is a benign tumor that usually occurs inside the milk ducts, just behind the brown part of the breast called the areola. It occurs with discharge and pain in the breast and is usually seen in women over 35 years of age. Ductal hyperplasia is defined as the excessive growth of the cells that form these channels in the breast tissue, and this condition often causes nipple discharge. In addition, excessive expansion of the ducts in the breast may cause nipple discharge. This condition, called ductal ectasia, is the cause of discharge at a rate as high as 15%. Finally, inflammatory breast lesions called mastitis are also among the rare causes of nipple discharge. All these diseases are pathological conditions that occur in the breast tissue, and nipple discharge that occurs in these cases should be closely monitored.
- Breast cancer is the most common type of cancer in women, and nipple discharge is one of the common symptoms of this cancer. Discharge due to breast cancer is most likely bloody in appearance and usually occurs spontaneously, from a single breast, usually from a single duct.
How to Treat Nipple Discharge?
Any breast disease should be seen first by a breast surgeon. Treatment of nipple discharge begins with taking a detailed history of the patient and a comprehensive breast examination. First of all, it is decided whether the nipple discharge is pathological or not. Depending on the patient’s age, current condition or examination findings, further examination with mammography and/or ultrasonography may be required. Breast MRI may be required in some patients. Nipple discharge should be examined carefully, especially in women over 40 and men of all ages. It may be necessary to perform a biopsy after physical examination and radiological examinations. Surgical intervention may be considered in pathological nipple discharge. It may be necessary to remove a single duct or all ducts behind the nipple. If nipple discharge is due to breast cancer, the necessary treatment for breast cancer is applied.
