Nipple Discharge — Evaluation & Treatment

Understanding Nipple Discharge

Nipple discharge is a relatively common breast concern experienced by many women. It can range from benign secretions related to hormonal changes to discharge that may require further evaluation and treatment. Most nipple discharge is not cancer, but certain features deserve careful assessment by a breast specialist.

Benign causes of nipple discharge can include:

Normal hormonal or menstrual changes
Fibrocystic breast changes
Milk production unrelated to pregnancy or breast-feeding (galactorrhea)
Benign intraductal papillomas
Duct ectasia (dilated ducts)
Inflammatory or infectious processes

When to seek evaluation:

Discharge that is spontaneous (comes out without squeezing)
Discharge from one breast or a single duct
Clear, serous, watery, or bloody discharge
Discharge associated with a lump or breast pain

How We Evaluate Nipple Discharge

Initial evaluation begins with a detailed history and physical exam, focusing on:

When the discharge occurs (spontaneous vs. expressed)
Whether only one duct or both breasts are involved
The color and consistency of the fluid
Any associated symptoms like a lump, pain, or skin changes

Breast Imaging

Appropriate imaging is a key part of the work-up:

Mammography helps evaluate underlying breast tissue changes
Breast ultrasound can locate intraductal lesions or cysts
MRI may be used when mammogram and ultrasound are inconclusive, especially in persistent or suspicious discharge

Lab Testing

Routine blood tests are not indicated for nipple discharge. Cytologic examination of discharge fluid has limited diagnostic value and is not typically used to make management decisions.

When Surgery Is Recommended

Not all nipple discharge requires surgery. However, surgical evaluation is often recommended when:

Discharge is spontaneous, unilateral, or from a single duct
There is bloody, serous, or watery discharge with no clear benign cause
Imaging shows a visible lesion such as a papilloma or ductal abnormality
Discharge persists despite normal imaging findings on mammogram and ultrasound

Duct Excision (Microdochectomy / Terminal Duct Excision)

A duct excision is both a diagnostic and therapeutic procedure:

The duct responsible for the discharge is removed
Tissue is sent to pathology to check for benign or malignant conditions
Most women with pathologic nipple discharge will benefit from this approach

In published series, benign disease is found in the majority of cases, but malignancy may be present in a subset of women with suspicious discharge, making careful evaluation and, in some cases, surgery important.

Personalized Planning and Care

Choosing the right approach depends on:

Your symptoms and history
Findings on physical exam and imaging
Whether one or multiple ducts are involved
Your preferences and long-term risk factors

Some women may have a duct excision based on clinical suspicion even if imaging is normal. In others, imaging results guide where a surgical biopsy should be performed.

Recovery After Duct Excision

Patients go home the same day
Discomfort is usually mild and managed with pain control
Cosmetic outcomes are an important consideration and will be discussed
Final pathology typically takes several days to about a week

We will review results with you in detail and plan any additional care based on the findings.

When to Contact Us

If you are experiencing nipple discharge that concerns you — especially spontaneous or single-duct discharge — we welcome your referral or consultation. We focus on careful evaluation, evidence-based care, and personal support throughout the diagnostic process.