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Nipple discharge

Nipple discharge

Postby Michie5 » Mon Nov 01, 1999 10:16 pm

I am a 28 year old woman with a long history of gyn problems. Recently I discovered discharge from my nipples, it is coming from several ducts in each nipple and is anywhere from green to milky in color. Along with this I have been having daily headaches for about 3 months and am experiencing extreme fatigue. My questions are; could all of these symptoms be related? And if so, what could be causing them?
With deep concern,
Michie5
Michie5
 

Nipple discharge

Postby Breast Health Team » Tue Nov 02, 1999 6:17 pm

INFORMATION FOUND WITHIN THIS MESSAGE SHOULD NOT BE USED FOR SELF TREATMENT. PLEASE SEE BELOW FOR ADDITIONAL MEDICAL DISCLAIMER.

Dear Michie5,

Thank you for your question about breast
discharge. The majority of nipple discharges are associated with non-cancerous changes in the breast such as hormonal imbalances. Please visit our comprehensive information about nipple discharge, online at http://www.imaginis.net/breasthealth/nipple.html. We have also inserted the majority of this information below.

>> It is possible that hormonal imbalances could cause the symptoms you describe below: nipple discharge, fatigue and headaches. Please consult with your physician.

Milky discharge (cloudy, whitish or almost clear in color, thin, non-sticky) is the most common type of discharge. Drugs or hormones that stimulate prolactin secretion can cause spontaneous, persistent production of milk (galactorrhea). Prolactin is the hormone produced by the pituitary gland
that starts the growth of the mammary glands and triggers production of milk. Some pituitary tumors cause excess prolactin secretion that can lead to milky nipple discharge, usually from both breasts (bilateral). Opalescent discharge that is yellow or green in color is normal.

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Nipple Discharge

Nipple discharge is the third most common breast complaint for which women seek medical attention, after lumps and breast pain. A woman's breasts have some degree of fluid secretion activity throughout most of the adult life. The difference between lactating (milk producing) and non-lactating breasts is mainly in the degree or amount of secretion and to a smaller degree in the chemical composition of the fluid. In non-lactating women, small plugs of tissue block the nipple ducts and keep the nipple from discharging fluid. During breast self-exam, fluid may be expressed from the breasts of 50% to 60% of Caucasian and African-American women and 40% of Asian-American women.

The majority of nipple discharges are associated with non-malignant changes in the breast such as hormonal imbalances. However, any woman with a suspicious or worrisome nipple discharge (see below) should consult her physician.

Nipple discharge is of concern if it is:
- bloody or watery (serous) with a red, pink, or brown color
- sticky and clear in color or brown to black in color (opalescent)
- appears spontaneously without squeezing the nipple
- persistent
- on one side only (unilateral)
- a fluid other than breast milk

Causes of nipple discharge:

Milky discharge (cloudy, whitish or almost clear in color, thin, non-sticky) is the most common type of discharge. Most milky discharge is caused by lactation or increased mechanical stimulation of the nipple due to fondling, suckling or irritation from clothing during exercise or activity. Drugs or hormones that stimulate prolactin secretion can cause spontaneous,
persistent production of milk galactorrhea). Prolactin is the hormone produced by the pituitary gland that starts the growth of the mammary glands and triggers production of milk. Some pituitary tumors cause excess
prolactin secretion that can lead to milky nipple discharge, usually from both breasts (bilateral). Opalescent discharge that is yellow or green in color is normal.

Most bloody or watery (serous) nipple discharge (approximately 90%) is due to a benign condition such as papilloma or infection. A papilloma is a non-cancerous, wart-like tumor with a branching or stalk that has grown inside the breast duct. Papillomas frequently involve the large milk ducts near the nipple. Multiple papillomas may also be found in the small breast ducts further from the nipple.

Of the benign conditions that cause suspicious nipple discharge, approximately half is due to papilloma and the other half is a mixture of benign conditions such as fibrocystic conditions or duct ectasia (widening and hardening of the duct due to age or damage). Most opalescent discharge
is due to duct ectasia or cyst.

Suspicious nipple discharge is due to a malignant (cancerous) lesion just ten percent (10%) of the time. Discharge caused by a malignant condition is almost always on one side only (unilateral). Discharge that is coming from both breasts (bilateral) is usually benign. Papilloma usually causes
discharge from a single breast duct.

Examination for nipple discharge:

A blood test of prolactin levels is often made to determine hormonal causes of excessive milky discharge (galactorrhea). A hormone imbalance, pituitary tumor, and certain drugs such as sedatives, tranquilizers, hormone replacement or birth control pills may cause excessive prolactin levels.

If there is a suspicious nipple discharge (see above criteria), an examination by a physician should be performed. Clinical breast exam (CBE) is first performed. If a discharge can be produced during the examination, some of the fluid may be collected and examined under a microscope to see if any blood cells or cancer cells are present. This test is called a nipple smear. The discharge may also be examined for signs of infection such as pus. Papillomas may be seen with microscopic examination of a nipple discharge, but this test may be inconclusive.

If the discharge is bloody or serous, a mammogram is often the first test to be performed. Even when no cancer cells are found in a nipple discharge, it is not possible to rule out breast cancer or other condition such as papilloma.

If a patient has a suspicious mass together with nipple discharge, evaluation of the mass should be performed using mammography, adjunctive imaging and biopsy as necessary. If these tests are negative and show no
malignancy, nipple smear should be evaluated.

Some papillomas are near the nipple and are large enough to be felt. In these cases, a needle biopsy can be done to test for malignancy or diagnose papilloma.

In some cases, a galactogram (also called a ductogram) is performed to aid in diagnosing the cause of an abnormal nipple discharge such as intraductal papilloma. However, a ductogram that does not show an abnormality does not exclude the fact that a significant lesion may be present.

Treatment for persistent nipple discharge:
The standard treatment for nipple discharge that has no hormonal involvement is duct excision. Duct excision is usually performed on an outpatient basis with local anesthesia. The procedure is usually done through a small circular incision near the areolar border around the nipple. It is not
uncommon for the pathology found to be so microscopic that it is invisible without the assistance of a microscope. Typically, nursing ability and nipple sensation are preserved after duct excision. Breast-feeding in the other breast should have no affect from the duct excision in the opposite breast.
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We hope that this information is helpful. However, please discuss this with your physician or other healthcare professional. Feel free to send Imaginis.net an additional post if you have other questions or would like clarification.

Thank you for using Imaginis.net. Best of luck with your follow-up.

Sincerely,

Imaginis.net Breast Health Team

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