Evaluation of a Nipple Discharge

 

Examination:

(1) Examine the nipples from each breast, looking for spontaneous discharge (discharge not due to breast compression or stimulation).

(2) Palpate each breast for masses.

(3) Gently but firmly compress each breast from the periphery towards the center, seeing if any fluid eminates from the nipple.

 

Parameters:

(1) triggering event

(2) color

(3) number of ducts showing discharge

(4) unilateral vs bilateral

(5) age of the patient

(6) palpable mass

Parameter	Probably Benign	Of Concern
triggering event	breast compression or stimulation	spontaneous
color	milky, green, gray, black	clear, serous, serosanguinous, bloody
number of ducts	multiple ducts	single duct
laterality	bilateral	unilateral
age	young	older
palpable mass	none	present

 

where:

• Each nipple has 5-10 duct openings.

 

Milky fluid (galactorrhea) may indicate:

(1) normal lactation

(2) lactation related to excessive prolactin (pituitary prolactinoma, other)

(3) galactorrhea due to medications (oral contraceptives, tranquilizers, phenothiazines, antihypertensive drugs, etc)

(3) other cause of galactorrhea

 

The workup may include:

(1) microscopic examination of the fluid

(2) Gram stain with bacterial culture

(3) biopsy or needle aspiration of any mass lesion

(4) measurement of serum prolactin level

(5) imaging studies of the breast (mammogram, ductogram, other)

(6) MRI of brain if pituitary adenoma suspected

(7) pregnancy test