Update on Nipple Discharge

In GP-bulletin by Karina Cox

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  • 90% of nipple discharge is benign.
  • Many women will have physiological over-production of breast secretions.
  • Coloured discharge, which is white, green or yellow and originates from multiple ducts, is usually benign.
  • Although many women are referred with single duct discharge, gentle breast massage will often demonstrate that discharge comes from multiple ducts or is bilateral.
  • Most women with an underlying carcinoma are over 50 years of age.
  • Nipple discharge under 50 years of age is usually benign secretions.
  • Copious bilateral ‘milky’ discharge may be secondary to a prolactinoma

For women with spontaneous multi-duct discharge (without a lump or any other breast symptom):

  • Pre-menopausal women with cyclical discharge can be reassured.
  • Smokers should be advised to reduce/ stop smoking and the underlying condition usually settles.
  • If nipple discharge persists in a post-menopausal woman, refer to a breast surgeon to discuss surgical management.

Spontaneous single duct unilateral discharge requires an urgent referral to a breast surgeon/ breast unit (2 week wait proforma).

  • The majority will have a benign cause such as a solitary duct papilloma but a small percentage (3%) will have an underlying malignancy.

Bloody nipple discharge in pregnancy is fairly common probably because of hypervascularity of the breast tissue. However, patients with this problem should still be urgently referred to a breast surgeon/ breast unit (2 week wait proforma).