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Nipple discharge

Female BreastFemale Breast
Intraductal papill...Intraductal papilloma
Mammary glandMammary gland
Abnormal discharge...Abnormal discharge from the nipple
Normal female brea...Normal female breast anatomy

Discharge from breasts; Milk secretions; Lactation - abnormal; Witch's milk (neonatal milk); Galactorrhea; Inverted nipple; Nipple problems; Breast cancer - discharge

Definition

Nipple discharge is any fluid that comes out of the nipple area in your breast.

Causes

Sometimes discharge from your nipples is OK and will get better on its own. You are more likely to have nipple discharge if you have been pregnant at least once.

Nipple discharge is most often not due to cancer (thus a benign condition), but rarely, it can be a sign of breast cancer. It is important to find out what is causing it and to get treatment. Here are some reasons for nipple discharge:

Pregnancy
Recent breastfeeding
Rubbing on the area from a bra or t-shirt
Injury to the breast
Breast infection
Inflammation and clogging of the breast ducts
Noncancerous pituitary tumors
Small growth in the breast that is usually not cancer
Severe underactive thyroid gland (hypothyroidism)
Fibrocystic breast (normal lumpiness in the breast)
Use of certain medicines such as birth control pills or antidepressants
Use of certain herbs, such as anise, blessed thistle, and fennel
Widening of the milk ducts
Intraductal papilloma (benign tumor in the milk duct)
Chronic kidney disease
Illicit drug use, including cocaine, opioids and marijuana

Sometimes, babies can have nipple discharge. This is caused by hormones from the mother before birth. It should go away in 2 weeks.

Cancers such as Paget disease (a rare type of cancer involving the skin of the nipple) can also cause nipple discharge.

Symptoms

Nipple discharge that is not normal is:

Bloody
Comes from only one nipple
Comes out on its own without you squeezing or touching your nipple

Nipple discharge is more likely to be normal if it:

Comes out of both nipples
Happens when you squeeze your nipples

The color of the discharge does not tell you whether it is normal. The discharge can look milky, clear, yellow, green, or brown.

Squeezing your nipple to check for discharge can make it worse. Leaving the nipple alone may make the discharge stop.

Exams and Tests

Your health care provider will examine you and ask questions about your symptoms and medical history.

Tests that may be done include:

Prolactin blood test
Thyroid blood tests
Head CT scan or MRI to look for pituitary tumor
Mammography
Ultrasound of the breast
Breast biopsy
Ductography or ductogram: an x-ray with contrast dye injected into the affected milk duct
Skin biopsy, if Paget disease is a concern

Treatment

Once the cause of your nipple discharge is found, your provider can recommend ways to treat it. You may:

Need to change any medicine that caused the discharge
Have lumps removed
Have all or some of the breast ducts removed
Receive creams to treat skin changes around your nipple
Receive medicines to treat a health condition

If all of your tests are normal, you may not need treatment. You should have another mammogram and physical exam within 1 year.

Outlook (Prognosis)

Most of the time, nipple problems are not breast cancer. These problems will either go away with the right treatment, or they can be watched closely over time.

Possible Complications

Nipple discharge may be a symptom of breast cancer or a pituitary tumor.

Skin changes around the nipple may be caused by Paget disease.

When to Contact a Medical Professional

Have your provider evaluate any nipple discharge.

References

Klimberg VS, Hunt KK. Diseases of the breast. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 35.

Leitch AM, Ashfaq R. Discharges and secretions of the nipple. In: Bland KI, Copeland EM, Klimberg VS, Gradishar WJ, eds. The Breast: Comprehensive Management of Benign and Malignant Disorders. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 4.

Sandadi S, Rock DT, Orr JW, Valela FA. Breast diseases: detection, management, and surveillance of breast disease. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 15.

Swartz MH, Nentin FG. The breast. In: Swartz MH, ed. Textbook of Physical Diagnosis: History and Examination. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 16.

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Review Date: 10/10/2022

Reviewed By: Jonas DeMuro, MD, Diplomate of the American Board of Surgery with added Qualifications in Surgical Critical Care, Assistant Professor of Surgery, Renaissance School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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