Introduction
Nipple discharge can be a benign sign—or a serious warning. From harmless lactation to breast cancer, understanding the color and pattern of discharge is vital. This article breaks down every type and cause, along with when to seek medical help.
What Is Nipple Discharge?
- Definition: any fluid (clear, milky, bloody, purulent) from the nipple
- May be physiological (normal) or pathological (abnormal)
- Can come from one or both breasts, one or multiple ducts
Types of Nipple Discharge by Appearance
1. Milky or Clear
Physiological causes:
- Lactation
- Witches’ milk in newborns
- Puberty-related lactorrhoea
2. Green or Yellow
- Fibrocystic disease: cyclical, tender, lumpy breasts
- Mammary duct ectasia: multiple ducts, intermittent, may be tender
3. Bloody Discharge
- Intraductal papilloma: single duct, retroareolar lump
- Carcinoma: may present with or without palpable lump
- Mammary duct ectasia (low-grade mastitis)
4. Purulent Discharge
- Acute mastitis: multiple ducts, associated with pain, redness
- Tubercular mastitis: chronic, rare, sterile cultures
Key Points to Remember
- Milky discharge is rarely pathological
- Purulent discharge is usually benign
- Bloody discharge often suggests neoplasm
- Always prioritize evaluating a lump over the discharge itself
Also read: Dysphagia – Difficulty in Swallowing
Causes of Nipple Discharge by Clinical Scenario
A. Discharge with a Palpable Lump
Investigate as for a breast lump
FNAC, imaging (mammography or ultrasound)Common pathologies:
- Carcinoma
- Intraductal papilloma
- Abscess
B. Discharge Without a Lump
Mammography first
If mammogram is positive → investigate accordinglyIf mammogram is normal:
- Bloody discharge: likely papilloma or duct ectasia
- Multiple ducts, tender: duct ectasia
- Green/yellow, lumpy: fibrocystic disease
Clinical Evaluation and Red Flags
- Single-duct vs multi-duct discharge
- Spontaneous vs expressed
- Unilateral vs bilateral
- Associated mass or skin changes
- Persistent or recurrent discharge
Red Flags:
- Blood-stained discharge
- Single duct involvement
- Presence of lump or skin changes
- Discharge in women >40 years
You may be interested in: Haemoptysis – Coughing Up Blood
Differential Diagnosis
Physiological
- Lactation
- Newborn or puberty-related milk production
Pathological
- Green/Yellow: Fibrocystic changes, duct ectasia
- Bloody: Papilloma, carcinoma
- Pus ± milk: Mastitis, abscess, TB
Investigations for Nipple Discharge
1. Microbiological Tests
- MC+S for mastitis, TB (Lowenstein-Jensen media)
2. Cytology
- Discharge sample analysis to detect carcinoma cells
3. Imaging
- Ultrasound (younger women): cysts, papillomas
- Mammography (older women): tumors, duct ectasia, calcifications
4. Duct Excision or Ductogram
- Reserved for recurrent or unexplained cases
- Helps exclude neoplasia
Related: Breast Lump - Signs & Symptoms
Treatment Options Based on Cause
1. Fibrocystic Disease
- Supportive bra
- Caffeine restriction, dietary changes
- Pain relief: NSAIDs
2. Mammary Duct Ectasia
- Observation if asymptomatic
- Antibiotics if inflamed
- Duct excision for recurrent cases
3. Intraductal Papilloma
- Surgical excision
- Regular follow-up
4. Carcinoma
- Triple assessment
- Surgery + chemo/radiotherapy
- Hormonal therapy if ER/PR positive
5. Mastitis/Abscess
- Antibiotics
- Incision and drainage if required
FAQs About Nipple Discharge
Is nipple discharge always cancer?
No. Most cases are benign. However, bloody or persistent discharge should be evaluated.
What if there is discharge but no lump?
You still need imaging and sometimes a biopsy, especially if the discharge is bloody.
Can infection cause nipple discharge?
Yes. Mastitis and abscesses are common infectious causes.
Does breast cancer always present with a lump?
No. It can present with bloody discharge or skin changes alone.
Can men get nipple discharge?
Yes, though rare. Always warrants thorough investigation.
Conclusion
Nipple discharge is common and mostly benign—but vigilance is key. Whether it’s green, yellow, or bloody, each type tells a story. With timely assessment and management, both reassurance and early detection of serious conditions are possible.
