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Discharge from breasts; Milk secretions; Lactation - abnormal; Witch's milk; Galactorrhea; Inverted nipple; Nipple discharge
Nipple problems can include tenderness, skin changes, changes in shape, or discharge from the nipple portion of the breast.
This article is about nipple problems or changes in women who are not breastfeeding or who have not just had a baby (postpartum).
Nipple tenderness or skin changes may be caused by:
The likelihood of nipple discharge increases with age. It is somewhat common in women who have had at least one pregnancy or are in the final weeks of pregnancy.
A milky nipple discharge is rare in men or women, but it does occur. When it occurs in men or in women who have never been pregnant, it is likely to be caused by an underlying disease. However, even then nipple discharge has many other causes that are NOT breast cancer, including:
Nipple inversion is a condition that you are born with. Nipple retraction may be caused by aging, duct ectasia, infections in the milk duct, or breast cancer.
Breast changes that may occur:
Changes in the shape of the nipples may include:
Nipple discharge may be:
Skin changes around the nipple may include:
The health care provider will take your medical history and perform a physical examination.
Tests that may be done to look for causes of nipple discharge:
Other tests that may be done include:
Treatment of nipple discharge caused by conditions outside of the breast include:
Abnormal findings on a mammogram or breast ultrasound will be biopsied and often removed.
Most women with breast discharge who have a normal mammogram, breast ultrasound, and physical exam can be followed safely over 1 - 2 years with a mammogram and physical exam repeated during that time.
Removing all or some of the breast ducts (called subareolar duct excision) may be done right away, or after a period of observation. Often a ductogram is done before surgery.
Steroid creams, antifungal creams, and antibiotic creams may be used to treat skin changes around the nipple.
For information on breast and nipple care while breastfeeding, see:
Most women with inverted nipples who give birth are able to breastfeed without complications.
In most cases nipple problems do not involve breast cancer. These problems will either go away with the right treatment, or they can be watched closely over time.
Nipple discharge may be a symptom of breast cancer or a pituitary tumor.
Skin changes around the nipple may be caused by Paget's disease.
Call for an appointment with your health care provider if:
Valea FA, Katz VL. Breast diseases: diagnosis and treatment of benign and malignant disease. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, PA: Mosby Elsevier; 2007:chap 15.
Leitch AM, Ashfag R. Discharges and secretions of the nipple. In: Bland KI, Copeland EM III, eds. The Breast: Comprehensive Management of Benign and Malignant Disorders. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 4.
Gray RJ, Pockaj BA, Karstaedt PJ. Navigating murky waters: a modern treatment algorithm for nipple discharge. Am J Surg. 2007;194:850-854.
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