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Nipple Discharge

Have you ever had a nipple discharge?  If so, it was probably an alarming experience.  You may be comforted to know that it is a common experience for women, however.  Nipple discharge is the third most common breast-related medical complaint women bring to their doctors, after lumps and breast pain.  But while these discharges are common, they are not "normal".  While it's typical to worry about breast cancer, the good news is that 9 out of 10 times, these discharges result from benign (non-cancerous) conditions.

It's impossible for a doctor to say what's causing your discharge without evaluating both you and the discharge.  If you have a discharge, your physician will probably do a thorough breast exam and try to express some of the material to send it for a Pap smear.  What could be causing it?  A milky discharge is usually from an elevated level of the hormone prolactin.  In evaluating a breast discharge, your doctor may recommend a blood test to measure your prolactin level.  Prolactin is a hormone produced by the pituitary gland, which is responsible for lactation.  Some pituitary tumors--even tiny ones called "microadenomas"--can cause excess prolactin secretion that can lead to milky nipple discharge, usually from both breasts.  Some medicines such as those for depression, anxiety, hormone replacement or birth control pills may also increase prolactin levels.  If you have an elevated prolactin level, don't assume you'll need brain surgery:  many of these tumors can safely and successfully be treated with medication.

Another cause of milky white nipple discharge is nipple stimulation from fondling, suckling or even irritation from clothing during exercise or activity.

Most bloody or watery nipple discharges result from a benign condition such as papilloma or from an infection. A papilloma is a non-cancerous, wart-like tumor with a stalk which grows inside the breast duct. Other benign conditions that cause suspicious nipple discharge include fibrocystic conditions or duct ectasia (widening and hardening of the duct due to age or damage).  A nipple discharge is more likely to be of concern if it is bloody or watery with a red, pink, or brown color; if it is sticky and clear or brown to black in color; if it appears spontaneously without squeezing the nipple; if it is persistent; if it occurs only on one side; or if it is a fluid other than breast milk.

Nipple discharge does not just affect women:  men may have nipple discharge as well.  Both male and female adolescents may experience a benign milky discharge during puberty. In adults, however, nipple discharge in men is more often associated with cancer than in women.

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Created: 10/2/2003  -  Donnica Moore, M.D.

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