Nipple discharge is the appearance of discharge from one or both mammary glands. The symptom may be accompanied by pain and discomfort in the chest, redness of the skin above the breast, changes in the areola area. The expiration of the secret is observed in inflammatory processes of the mammary glands, benign and malignant tumors, pathologies of the endocrine system. Ultrasound, mammography, and laboratory tests are performed to determine the causes. To alleviate the condition, analgesics can be prescribed, other drugs are used after verification of the diagnosis.
General characteristics
Most often, women themselves notice signs of discharge from the nipples during hygiene procedures, changing clothes. Often the discharge looks like droplets of dried secretions in the areolar region, spots on the bra formed by a small amount of liquid contents of various colors. Sometimes the liquid or thick secret flows out only after pressing on the chest. In some cases, there is a connection between the appearance of the symptom and the phases of the menstrual cycle, sexual acts, and the use of hormonal methods of contraception.
Nipple discharge may have an unpleasant putrid or fetid smell. The symptom is more often accompanied by a feeling of heaviness and discomfort in the mammary glands. Sometimes patients notice redness of the breast skin, rashes in the nipple area. Secretions that are not associated with pregnancy and lactation indicate the presence of pathology on the part of the breast or other organs, therefore, in such situations, a specialist’s consultation is indicated. Pregnant and lactating women who have noticed an atypical color discharge from the nipples should also consult a doctor.
Classification
The outflow of liquid secretions from the mammary glands can be both physiological and pathological. Depending on the prevalence of the process, unilateral and bilateral forms are distinguished, according to the conditions of occurrence — spontaneous and caused by breast stimulation. In clinical practice, a classification based on the appearance of the discharge is common, which suggests pathogenetic moments and the root cause of unpleasant manifestations. Based on this criterion , the following types of symptoms are distinguished:
- Colostrum-like discharge (galactorrhea). The secret in its chemical composition is breast milk, the pituitary hormone prolactin is responsible for its synthesis. The discharge of colostrum from one or two mammary glands is caused by excessive stimulation of the glandular apparatus. An increase in prolactin production occurs both with pituitary gland damage and with indirect exposure to various hormonal substances.
- Serous discharge. The transparent liquid that flows out of the nipples appears as a result of the release of blood plasma from the vessels into the ducts. The symptom may have physiological prerequisites: the discharge is occasionally observed during sexual intercourse, when wearing tight bras. The outflow of serous fluid is characteristic of the initial period of inflammatory processes, light bruises of the chest.
- Green highlights. The thick green discharge consists of the exfoliated epithelium of the thoracic ducts and single leukocytes. The characteristic coloration is due to the prolonged stagnation of pathological secretions in the milky passages during their expansion. The symptom may also be associated with the formation of cysts in the chest, in which there is an accumulation of viscous secretions, accompanied by chronic inflammation.
- Purulent discharge. Typical thick yellow-green pus flows from the nipples during bacterial inflammatory processes. The color of the discharge is associated with the presence of a large number of dead neutrophils (cells that destroy pathogenic bacteria). With different activity of the process, the amount of secretion ranges from a few drops to massive suppuration when opening an abscess.
- Spotting. In some cases, the discharge has a bright red or burgundy-brown color, which depends on the prescription of bleeding. Sometimes the sucrose flows out of the nipple. Blood is released when benign papillomas are injured, malignant tumors disintegrate. After a blow to the chest area, the glandular lobules and ducts are damaged, which is also manifested by bleeding.
Causes of nipple discharge
Causes of colostrum-like discharge from the nipples
The separation of milk-like secretions from the breast may be associated with natural factors, but it also occurs with a number of hormonal disorders. The most common causes of colostrum-like secretions are:
- Physiological: pregnancy and breastfeeding, intensive stimulation of the nipples.
- The consequences of medical, vacuum or surgical abortion.
- Diseases of the pelvic organs: endometriosis, inflammation of the uterus, Chiari-Frommel syndrome.
- Pathology of the hypothalamic-pituitary system: malignant neoplasms, prolactin-secreting tumors of the pituitary gland, empty Turkish saddle syndrome.
- Other endocrine disorders: acromegaly, primary hypothyroidism, Itsenko-Cushing’s disease.
- Internal organ damage: ectopic prolactin secretion in bronchogenic carcinoma, liver disease, chronic renal failure.
- Complications of pharmacotherapy: taking psychotropic drugs, oral contraceptives, some antihypertensive drugs.
Causes of green discharge from the nipples
Grayish-greenish or green discharge from the nipples is extremely rarely caused by neoplasms. In most cases, their cause is a benign pathology of the mammary glands:
- Ectasia of the milk ducts.
- Mastopathy: fibrocystic form, breast adenosis.
- The initial stage of intra-flow papilloma.
Causes of purulent discharge from the nipples
A thick yellow or yellow-green secret with an unpleasant odor signals an acute infectious process. Purulent discharge from the nipples occurs in the following diseases:
- Mastitis: non-lactational, postpartum, galactophoritis.
- Complications of mastitis: breast abscess, formation of a fistula.
- Infection of the skin around the nipple: boils and carbuncles.
Causes of bloody discharge from the nipples
Serous-bloody or bloody discharge from the nipple is a serious signal that requires the exclusion of neoplasms of various nature. The most likely causes of a bloody or bloody discharge:
- Injuries, bruises of the breast.
- Benign formations: intra-flow papilloma, fibrocystic changes.
- Malignant tumors: breast adenocarcinoma, Paget’s cancer, invasive ductal carcinoma.
Causes of nipple discharge in men
Liquid or viscous discharge from the breast in men is formed with the same diseases as in women — traumatic injuries, uncomplicated and complicated mastitis, benign neoplasia, breast cancer, hypothalamic-pituitary dysfunction, etc. The nature of the secret is determined by the disease that provoked its occurrence. With particular caution, secretions that appeared for no reason against the background of gynecomastia and are combined with an asymmetric enlargement of one breast, axillary lymphadenopathy should be perceived.
Diagnostics
The primary examination of women with complaints of nipple discharge is carried out by a specialist mammologist. The doctor selects laboratory and instrumental methods, which are primarily aimed at studying the condition of the mammary glands, identifying suspicious structural changes or signs of inflammation. The greatest diagnostic value are such studies as:
- Ultrasound scanning. With the help of sonography, breast tissue is visualized, structural anomalies and volumetric formations are detected. The method is absolutely safe, so it is prescribed even for pregnant women. Ultrasound of the mammary glands is more often used in young women, because their breasts have a dense structure that is clearly visible during the study.
- Mammography. X-ray examination of the breast is aimed at detecting neoplasms or fibrous changes that could cause the discharge of secretions from the nipples. The method is more informative after 40 years. To clarify the diagnosis, mammography is supplemented with ductography – contrast of the milky ducts.
- Breast biopsy. In the presence of a volumetric shadow, a fine-needle biopsy or a trepan biopsy of the breast is used under the control of an ultrasound machine. The obtained biopsies are sent for cytomorphological analysis to determine the cellular composition and possible signs of malignancy.
- Examination of secretions. At the expiration of purulent or cloudy serous secretion, sowing of the separated on nutrient media is shown. The method is necessary for the identification of a pathogenic pathogen. Additionally, the sensitivity of microbes to antibiotics is being studied. Be sure to make a guaiac test, which helps to exclude bleeding from the chest.
- Blood tests. In addition to standard laboratory tests, when complaining of nipple secretion, the level of sex hormones and prolactin in the blood is determined. To exclude neoplasia, a blood test is prescribed for the main cancer markers. Advanced biochemical analysis makes it possible to identify signs of the inflammatory process.
According to the indications, an MRI mammography is performed in order to clarify the diagnosis. If the discharge from the nipples has an unclear etiology, targeted radiography of the Turkish saddle, CT and MRI of the brain are recommended to exclude pathologies of the hypothalamic-pituitary zone. Taking into account the detected changes, consultations of other specialists (endocrinologist, oncologist) may be required.
Treatment of nipple discharge
Help before diagnosis
The detection of an unusual discharge from the breast is an indication for contacting a doctor. Attempts at self-medication can provoke the progression of the disease and serious complications. To reduce unpleasant sensations in the chest that violate the quality of life, various analgesics and anti-inflammatory drugs from the NSAID group are used. Patients during lactation who have serous or purulent discharge are recommended to express milk regularly to prevent lactostasis.
Conservative therapy
Medical tactics depend on the disease that caused the discharge of mammary gland secretions from the nipples, the age of the patient, the presence of pregnancy, extragenital pathology also matters. Etiotropic and pathogenetic agents are selected for treatment. Complex therapy includes medications, physiotherapy methods. The following groups of medicines are most often prescribed:
- Antibiotics. These medications are used in all cases of bacterial breast damage. At the beginning of treatment, the selection of drugs is carried out empirically, the therapy regimen is usually adjusted after receiving the results of bacteriological seeding. Most often, antibiotics from the group of beta-lactams, macrolides are used.
- NSAIDs. Anti-inflammatory drugs are indicated as pathogenetic therapy for mastitis, the consequences of breast injuries. The drugs improve general well-being, eliminate pain, well stop local signs of inflammation. NSAIDs are prescribed with caution in the presence of concomitant gastrointestinal diseases (ulcers, gastritis).
- Hormonal agents. For the treatment of various forms of mastopathy, antiestrogens are recommended – medications that reduce the effect of sex hormones on breast tissue, prevent the proliferation of fibrous tissue. Oral contraceptives are prescribed to reduce the concentration of estrogens, normalize the hormonal background.
- Cytostatics. Chemotherapy drugs are used for malignant neoplasms of the mammary glands as an independent method or as a preparation for surgical treatment. Therapy regimens are selected individually, taking into account the results of cytological and molecular diagnostics. Treatment can be supplemented with radiation therapy.
Surgical treatment
In complicated forms of mastitis, autopsy and drainage are indicated. If the discharge is caused by benign or malignant tumors, surgical intervention is recommended. Based on the data on the stage of the disease and the histological characteristics of the tumor, different types of surgical operations are prescribed: excision of a fibrous node or cyst, sectoral resection of the breast, lumpectomy. Diffuse breast changes, the presence of a malignant neoplasm are indications for radical mastectomy followed by mammoplasty.
