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Reed Kuehn icon expert
A breast leaking fluid when it shouldn’t be can be scary. While most nipple discharge is harmless, requiring only reassurance and a positive clinical encounter, there are instances where you're going to need a little more help. Characteristics of the discharge, combined with a complete history and physical (including family history) can assist your medical professional in determining if there is an underlying problem that needs to be addressed. While anything new in the breast should be clinically evaluated, most breast discharge is benign and will require little to no intervention. Characteristics of the discharge can help identify the cause and of these, color is one of the most important. The fluid can come in a variety of colors including white, green, black, brown, red, and clear. Often, the biggest concern of any patient with new-onset breast discharge is if they have cancer. In a young patient with no increased genetic predisposition (BRCA or other gener), cancer is uncommon but can occur. Discharge related to breast cancer is usually spontaneous (AKA without stimulation), is pink or clear in color, comes from a single breast, and is accompanied by a solid lump. Any of these conditions should raise concern and prompt immediate clinical evaluation by a medical professional with knowledge of breast disease. A small drop or two of white or milky discharge following manual manipulation or stimulation is physiologic and completely benign and requires no treatment. Higher volume bilateral milky discharge is called galactorrhea, and has the appearance of lactation with a recent pregnancy. It can be due to an increase in the hormone prolactin and may be caused by medications such as estrogen and sedatives, marijuana use, or (rarely) a tumor in the brain. High prolactin levels will usually lead to a more thorough evaluation. Yellowish-white, yellowish-green discharge or pus can be indicative of an underlying infection or abscess. The affected breast is often swollen, painful, and red on usually just one side. Patients who are smokers, have piercings, or sustain an injury to the breast are at increased risk of developing breast infections and abscesses. Antibiotics and warm compresses are usually the first treatment options but ultrasound guided aspirations or surgery to drain the abscess may be required if there is no improvement. Cheese-like or brown discharge can be a sign of another benign breast process call duct ectasia. It most often occurs in postmenopausal women when the breast ducts dilate and get clogged. Additional benign processes such as fibrocystic disease, mastitis, and menstrual cycle changes can also cause nipple discharge of multiple colors. In the end, most nipple discharge is not dangerous and treatment requires little to no intervention, but some causes are dangerous so all nipple discharge should be evaluated by a medical professional knowledgable in breast disease.
3 years ago
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