Nipple discharge is fluid from the nipple, with or without squeezing the breast. The discharge can be milky, clear, green, purulent, bloody, or faintly yellow. The consistency can be thick, thin, sticky, or watery.

Symptoms of breast cancer include a lump in the breast, bloody discharge from the nipple and changes in the shape or texture of the nipple or breast.

Nipple discharge that’s spontaneous, unilateral involving the single breast and blood stained may be early signs of breast cancer and should not be ignored.

Causes of nipple discharge

There are many cause of nipple discharge in addition to pregnancy and breastfeeding. They include:

• breast cancer
• ductal carcinoma in situ (DCIS)
• abscess or infection
• hormone replacement therapy and hormonal birth control
• excessive breast stimulation
• fibrocystic breast changes such as breast lumps, breast cysts, and breast pain.
• injury or trauma to the breast
• intraductal papilloma
• galactorrhea
• hormonal changes during the menstrual cycle
• medications
• mammary duct ectasia
• paget’s disease of the breast
• mastitis and periductal mastitis
• prolactinoma

Commonest cause of a nipple discharge is an

Intraductal papilloma.

It’s a benign (non-cancerous) lesion, however has a small risk  of cancer. The presentation can be with a bloody discharge or it may be picked up on routine screening. The mass within the duct may be anywhere along the duct. The further away from the nipple areolar complex (NAC) , the more likely it is to be malignant ( cancerous)

The only management necessary is accurate diagnosis. A histological diagnosis is required to differentiate between benign papilloma and a papillary carcinoma. As the lesion is generally smaller a core biopsy may be difficult and a vacuum-assisted biopsy may be considered. Alternatively a surgical excision is performed.

If there’s a bloody discharge from the nipple, a microductectomy ( nipple duct surgery) should be done.

Nipple discharges can also present with an underlying breast mass/lump and as such needs a thorough breast examination like all breast mass presentations.

1. Medical history
2. Clinical examination

3.  Breast Imaging in the form of a Mammogram or ultrasound depending on a patient’s age.

4. Biopsy to exclude cancer.

If you have nipple discharge outside of pregnancy and breastfeeding and it lasts for more than four weeks or you have any of the associated symptoms( lump, bloody, spontaneous) you should see your doctor.