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What is nipple discharge?
It is possible to express a bit a fluid from the nipples of most women regardless of age. The fluid is usually milky, green, or brown. This is normal and not a sign of cancer. There are some specific types of nipple discharge that warrant closer evaluation:
- Discharge that is bloody or clear-yellow, that occurs all by itself (e.g. it stains your clothes), and that comes from only one duct is considered a “pathologic” discharge that requires further assessment. This type of discharge is usually caused by a benign polyp in a large milk duct just deep to the nipple. When it occurs in older women it can be a sign of cancer.
- Copious milky discharge from both nipples can be a sign of pregnancy, but it can also be caused by a benign tumor in the pituitary gland (prolactinoma).
How do I know when to see a breast specialist?
Generally, any discharge that occurs all by itself in a woman who is not pregnant should be evaluated by a breast specialist.
How will I be evaluated for nipple discharge?
Your physician will give you a clinical breast exam, ask about your personal medical history, and probably order a mammogram and ultrasound to look for the source of the discharge. Ultrasound is very useful at evaluating causes of nipple discharge. Your physician may also order a ductogram, which involves instillation of dye into the discharging duct to visualize the interior. In some cases, a biopsy will be performed. For patients who are not pregnant but do have a copious milky discharge from both breasts, blood will be drawn to measure prolactin levels.