Definition
Any fluid (which may be physiological or pathological) emanating from the nipple.
Key Points
- Milky discharge is rarely pathological.
- Purulent discharge is usually benign.
- Bloody discharge is often associated with neoplasia.
- If a lump is present, always investigate ‘for the lump’ rather than ‘for the discharge’.
Differential Diagnosis
Physiological Discharges
Milky or Clear
- Lactation.
- Lactorrhoea in the newborn (‘witches’ milk’).
- Lactorrhoea at puberty (may be in either sex).
Pathological Discharges
Serous Yellow-Green
- Fibrocystic disease: cyclical, tender, lumpy breasts.
- Mammary duct ectasia: usually multiple ducts, intermittent, may be associated with low-grade mastitis.
Bloody
- Duct papilloma: single duct, ?retro-areolar, ‘pea-sized’ lump.
- Carcinoma: ?palpable lump.
- Mammary duct ectasia: usually multiple ducts, intermittent, may be associated with low-grade mastitis.
Pus ± Milk
- Acute suppurative mastitis: tender, swollen, hot breast, multiple ducts discharging.
- Tuberculous (rare): chronic discharge, periareolar fistulae, ‘sterile’ cultures on normal media.
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