When nipple discharge is normal and when it’s not

Nipple discharge is any fluid that comes out of your nipple, and is often a normal part of breast function. Many women - especially when squeezing their nipple - will see small amounts of fluid seeping out, which can be very alarming at first.

The discharge can come in a variety of colours and appear at any time. The colour and consistency of the discharge, however, may give you a clue as to what may be causing it.

Mr Mohsin Dani is a leading consultant breast and oncoplastic surgeon who describes the possible causes of nipple discharge and talks us through his diagnosis and treatment process. Keep reading to learn more.

Overview of normal nipple discharge

Nipple discharge is physiological and completely normal. It is common to have clear, milky or even greenish discharge throughout your reproductive years.

Liquid may seep out of your breasts on its own, or you may have to squeeze your nipple to get the fluid to come out. This is often routinely advisable as part of a breast examination.

Which symptoms indicate that nipple discharge isn’t normal?

Most of the time, breast discharge is not serious, but there are times when it can be a sign of breast cancer or that something isn’t as it should be. Signs to looks out for include:

• Spontaneous nipple discharge which happens on a regular basis without squeezing
• Your breast is producing a large volume of discharge
• The discharge is blood stained (red, brown or black)
• It usually comes out of a single duct (point) or one breast only

There are lots of benign (non-cancerous) reasons for these types of symptoms, however, a full investigation from a specialist is always recommended.

What are the possible causes of abnormal nipple discharge?

The following are some possible benign (non-cancerous) causes of nipple discharge:

• Hormone changes: normal changes in hormone levels, such as those that occur during menstruation may cause nipple discharge.
• Dilated milk ducts: ectasia is the term used to describe a condition where the milk ducts in the breast widens and the walls thicken. The duct then becomes blocked and fluid builds up. It most affects women that are nearing menopause and after menopause. This discharge can be green, brown and sometimes even black and very thick.
• Pregnancy: nipple discharge can occur both during and after pregnancy. Colostrum is the first breastmilk produced in mid-pregnancy and continues for a few days after the birth of your baby. It can appear as thin and light-yellow in colour at first and then become thicker and milkier.
• Papilloma (benign): noncancerous lumps that can form in your breast and cause discharge. They do not grow aggressively and do not spread.
• Infections: it is possible for some infections, e.g. mastitis, to cause a green discharge along with fever and tenderness.

Is it ever a sign of cancer?

Very rarely; however, when it is, it’s is a sign of very early cancer which is known as ductal carcinoma in situ (DCIS). This is when the cells that line the milk ducts become cancer. As it is a very early form of cancer, it is easily treatable and curable.

If nipple discharge is associated with an underlying lump, or other nipple changes like indrawing of nipple, then this can be more suspicious.

How would you diagnose the condition?

I always investigate all cases of nipple discharge with a combination of a mammogram (if patient is above the age of 35) and an ultrasound scan. In some cases, my team and I will also perform an MRI scan of the breast.

Sometimes, I may need to perform a small surgical procedure under general or local anaesthetic to remove small bits of tissue for further investigation.

How would nipple discharge be treated?

The treatment depends on the findings. Most benign cases don’t need any treatment as most will clear up alone.

Infections will often be treated with antibiotics, but if an abscess if present, we may need to drain it too.

If cancer is found, then we will deal with it according to the nature and progression of the disease. Some treatment options may include surgery, radiotherapy and chemotherapy.

If you are concerned about your nipple discharge and associated symptoms, visit Mr Mohsin Dani’s Top Doctors profile and check his availability.