Summary![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
Nipple discharge in non-lactating women can be classified as either galactorrhea or non-milky nipple discharge. Galactorrhea is usually caused by hyperprolactinemia and is associated with endocrine disorders or medication. Most of the causes of non-milky nipple discharge are benign, with less than 15% of cases related to cancer. The diagnostic approach is based on patient history and the characteristics of the discharge. Spontaneous, unilateral, and/or bloody nipple discharge, especially in women older than 40 years, should raise suspicion of malignancy. Treatment depends on the underlying disorder.
Overview![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
Physiological nipple discharge
- Definition: bilateral nipple discharge, typically milky
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Etiology
- Lactation
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Galactorrhea: milk production in non-breastfeeding women or men ; [1]
- Discharge varies in color (clear, white, yellowish, or greenish)
- Endocrine causes include hyperprolactinemia and primary hypothyroidism
- Discharge may also be only unilateral
- Chronic nipple stimulation; (e.g., piercings; , tight clothing, etc.)
Pathological nipple discharge
- Definition: unilateral, non-milky nipple discharge
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Etiology
- Benign causes: intraductal papilloma (52–57% of cases); , mammary duct ectasia; , fibrocystic changes, breast abscess
- Malignancy; : 5–15% of cases (mostly ductal carcinoma in situ)
Diagnostics![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
Patient history and clinical breast examination
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Features that should raise concern for malignancy
- Discharge that is unilateral, uniductal, persistent, spontaneous, and/or bloody or serosanguineous
- Presence of a breast mass
- Presence of risk factors for breast cancer (e.g., advanced age, positive family history)
Further diagnostics
Diagnostics | |
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Physiological nipple discharge |
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Pathological nipple discharge |
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Biopsy is mandatory if malignancy is suspected.
Treatment![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
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Galactorrhea
- See “Therapy” in hyperprolactinemia.
- In the case of normoprolactinemic galactorrhea: reassurance and avoidance of nipple stimulation
- Non-milky nipple discharge: : Treatment depends on the underlying disorder and can be found under respective causes (e.g., terminal ductal excision in the case of intraductal papilloma).