Purulent nipples discharge is a yellow-green discharge with an unpleasant odor from one or two mammary glands. The symptom is accompanied by sharp chest pains, local redness and swelling of the skin, and an increase in body temperature. The main cause of purulent discharge is various forms of mastitis and their complications, suppuration from the nipples is also observed with areola boils, breast injuries. To identify the cause of the condition, ultrasound, mammography, bacteriological seeding of the discharge is performed. Analgesics and anti-inflammatory drugs are used to relieve symptoms.
Causes of purulent nipples discharge
Mastitis
Purulent discharge is most often caused by inflammation of the breast. In 90% of cases, this is due to breastfeeding (lactation mastitis). Droplets of purulent nipples discharge appear after pressing on the chest, their release can be facilitated by squeezing the breast with a tight bra. Mastitis is characterized by a lesion of only one breast, which is manifested by a sharp asymmetry due to tissue edema. Women note a combination of secretions with redness of the skin, sharp soreness of the lesion area, an increase in temperature.
Non-lactational mastitis proceeds with a similar clinical picture. Some patients associate the presence of purulent discharge with bruising of the chest, skin injuries (cuts, abrasions). The discharge of pus from one nipple begins when pressing on the area of the areola. The symptom is accompanied by unbearable pain in the chest, the skin in this area becomes red and very hot to the touch. Suppuration from the nipple is a sign of a severe bacterial lesion of the glandular tissue, so the patient needs to seek medical help as soon as possible.
Breast abscess
Without treatment, the inflammatory disease often turns into a breast abscess — a massive formation filled with pus. This condition is combined with the periodic spontaneous appearance of purulent nipples discharge, blood clots and impurities of necrotic tissues can be found in the discharge. The mammary gland is very swollen, women complain of sharp pains at rest, which increase with movements. Suppuration with the release of scanty thick yellow-green contents is also found in the formation of fistulas due to chronic inflammation.
Local purulent processes
The cause of the discharge of pus from the nipples can be inflammatory skin lesions – boils and carbuncles, if they are localized in the area of the areola. A pathological discharge appears when an abscess is opened into the lumen of the milky passages. Patients note the sudden appearance of thick greenish pus with a sharp unpleasant odor, the amount of purulent discharge varies from a couple of drops to several milliliters. A painful hyperemic elevation is found on the skin of the breast, closer to the nipple. After the discharge of pus, the condition improves, the pain subsides.
Rare reasons
- Surgical complications: infection of breast tissues after surgical interventions.
- Suppuration of neoplasms: intra-flow papillomas, adenocarcinomas.
- Damage to the nipples: non-compliance with the technique of pumping milk, the presence of piercing.
- Purulent cyst of the breast.
Diagnostics
Examination of patients with suppuration from the nipples is carried out by a specialist mammologist or surgeon. During the diagnosis, the doctor collects a detailed anamnesis, conducts an external examination and palpation of the mammary glands to make a preliminary diagnosis. To establish the causes of purulent discharge, a complex of laboratory and instrumental methods is prescribed, the most informative of which are:
- Ultrasound examination. Sonography is a non-invasive diagnostic method that is recommended in all cases of nipple discharge. With the help of ultrasound of the mammary gland, the structure of the alveolar tissue and the milky ducts are visualized, deformities, cysts, and other volumetric neoplasms are detected.
- X-ray examination. Mammography is more informative in patients after 40 years of age, whose breast tissue is less dense. On the X-ray, the doctor evaluates the structure of glandular tissue, its uniformity and echogenicity. To clarify the diagnosis, if necessary, a CT scan of the mammary glands is performed.
- Laboratory methods. An accurate determination of the type of pathogenic microorganism that caused purulent inflammation is necessary for the selection of a treatment regimen. Bacteriological seeding is supplemented by rapid bacterioscopy of pus smears, a study of the sensitivity of the isolated microflora to antibiotics. To detect non-specific signs of the inflammatory process, general and biochemical blood tests are shown.
If a volumetric formation is detected, a puncture under ultrasound control is necessary, which allows differentiating abscesses with suppuration of the tumor formation. Cytological examination of purulent discharge from the nipple is carried out in doubtful cases to exclude oncological pathology.
Treatment
Help before diagnosis
The appearance of purulent nipples discharge indicates a massive inflammatory process in the mammary glands, so self-medication can lead to severe complications and generalization of infection. It is impossible to specifically compress the chest and areola to squeeze out pus, it is undesirable to wear tight bras, because they increase unpleasant sensations. With unbearable pain in the affected chest, various analgesics are used. Self-administration of antibiotics without a doctor’s appointment is fraught with the transition of the disease into a chronic form, which is less amenable to treatment.
Conservative therapy
Medical tactics depend on the degree of tissue damage, the presence of encapsulated purulent foci, the general condition of the woman. Drug treatment as an independent method is used only in the early stages of the disease. During treatment, the mammary gland is given an elevated position to reduce pain. Nursing mothers should regularly use a breast pump to prevent lactostasis. When suppuration from the nipples is prescribed:
- Antibiotics. Etiotropic drugs are selected taking into account the sensitivity of the pathological microflora. Drugs of cephalosporins or penicillins are initially administered, and combinations of antibiotics are used in severe bacterial process.
- NSAIDs. Medications reduce the concentration of inflammatory molecules in the breast tissues, thereby reducing the pain syndrome in patients. In case of severe pain, anti-inflammatory drugs with a powerful analgesic effect are selected.
- Infusion formulations. Intravenous administration of glucose-salt and protein solutions is recommended for detoxification of the body with extensive purulent inflammation. The drugs can be used together with antihistamines and immunomodulators.
Surgical treatment
The accumulation of pus in the mammary gland is an indication for a small surgical intervention — opening purulent foci and installing drains. In the presence of a single abscess of small size, they are usually limited to puncture of the formation under the control of ultrasound, followed by aspiration of the contents. With the formation of a large abscess, purulent melting of glandular tissue, autopsy and drainage of mastitis, extended operations, including excision of the affected areas (sectoral resection, quadrant), are necessary.
