II. History

  1. Pregnancy and Lactation history
    1. Galactorrhea is normal during pregnancy and for up to one year after cessation of Lactation
  2. Does the Nipple Discharge occur spontaneously?
    1. "Does discharge stain underclothing or bed clothing?"
  3. What Color is the Nipple Discharge?
    1. Bloody Nipple Discharge is NOT synonymous with cancer
    2. However bloody Nipple Discharge carries a higher risk of cancer
  4. Is more than one duct involved?
  5. Is the Nipple Discharge Unilateral or Bilateral?
  6. How long has the Nipple Discharge been present?
  7. Is the Nipple Discharge persistent?

III. Evaluation

  1. Non-Spontaneous Discharge (with Breast manipulation)
    1. Normal Breast Secretions
  2. Spontaneous Nipple Discharge (10% Breast Cancer)
    1. Unilateral Nipple Discharge
      1. Multiple Duct
        1. Probable benign Breast pathology
        2. Follow-up exam only
      2. Single Duct
        1. Probable Breast pathology or Breast Cancer
        2. Normal Mammogram and breast Ultrasound does not exclude pathology
        3. Surgically excise involved ductal system and send for pathology
          1. Involved ductal system can be identified with dye injection into duct with discharge
          2. Sauter (2004) Surgery 136:780-5 [PubMed]
    2. Bilateral Nipple Discharge
      1. Galactorrhea
        1. Probable systemic cause (Endocrine cause)
        2. See Galactorrhea
      2. Non-Galactorrhea
        1. See Unilateral Nipple Discharge above

IV. Types: Discharge associated with Cancer

  1. Watery: 45%
  2. Sanguineous: 25%
  3. Serosanguinous: 12%
  4. Serous: 6%

V. Causes

  1. Galactorrhea
    1. See Hyperprolactinemia Causes
    2. See Medication Causes of Hyperprolactinemia
  2. Bloody Nipple Discharge Etiologies
    1. Intraductal Papilloma (most common)
    2. Duct ectasia (Benign Breast duct tortuosity)
    3. Breast Cancer (represents <3%)

VII. Evaluation: Spontaneous Nipple Discharge

  1. Pressure point exam
    1. Elicit discharge from periphery toward nipple
    2. Distribute pressure evenly from each number of clock
    3. Document location that elicits Nipple Discharge
  2. Cytology
  3. Galactogram (Ductogram)
    1. Inject Radiocontrast Material into involved duct
  4. Culture and sensitivity are not useful
    1. Usually grows skin contaminant

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Ontology: nipple discharge (C0149741)

Definition (NCI_NCI-GLOSS) Fluid that is not milk coming from the nipple.
Concepts Sign or Symptom (T184)
ICD10 N64.52
SnomedCT 54302000, 139444000, 139447007, 155960006, 290107000, 162167000, 162164007
LNC LP7442-9, MTHU007943
English BREAST DISCHARGE, Nipple discharge, Nipple discharge NOS, Obs nipple discharge, nipple discharge (symptom), Discharging nipple, breast discharge, breast discharges, discharge from nipple, nipple discharge (diagnosis), discharge of nipple, Nipple discharge NOS (finding), Observation of nipple discharge (finding), Breast discharge, Discharge from nipple, Nipple discharge symptom, Observation of nipple discharge, Discharge from nipple (disorder), Nipple discharge symptom (finding), breast; discharge, discharge; breast, discharge; nipple, nipple; discharge, Nipple Discharge, nipple discharge
Italian Secrezione mammaria, Secrezione del capezzolo, Secrezione dal capezzolo
Dutch tepeluitvloed, uitvloed tepel, afscheiding; mamma, afscheiding; tepel, mamma; afscheiding, tepel; afscheiding, borstuitvloed
French Ecoulement du mamelon, Mamelon avec écoulement, ECOULEMENT MAMMAIRE, Ecoulement mammaire
German Brustwarzenabsonderung, sekretierende Brustwarze, ABSONDERUNG BRUSTDRUESE, Brustdruesenabsonderung
Portuguese Corrimento mamilar, Mamilo com corrimento, SECRECAO MAMARIA, Corrimento mamário
Spanish Pezón secretor, Secreción del pezón, PEZON, EXUDADO, derrame por el pezón (trastorno), secreción por el pezón (trastorno), secreción por el pezón, derrame por el pezón, derrame mamario, secreción del pezón, SAI, Nipple discharge NOS, secreción del pezón, SAI (hallazgo), síntoma de secreción del pezón (hallazgo), síntoma de secreción del pezón, Secreción mamaria
Japanese 乳頭分泌, 乳房分泌, ニュウトウブンピツ, ニュウトウブンビツ, ニュウボウブンピ, ニュウボウブンピツ, ニュウトウブンピ
Czech Výtok z prsu, Výtok z bradavky
Hungarian Emlő váladékozás, Váladékozó emlőbimbó, Emlőbimbó váladékozás