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Nipple Discharge in Men
Both male and female adolescents may
experience a milky discharge during puberty. Nipple discharge in the adult male is more
often associated with a malignant condition than in the female. Mammography should be
performed and biopsy should be performed if a mass or mammographic abnormality is found.
Bloody Discharge During
Pregnancy and Lactation
Bloody discharge during
pregnancy/lactation is fairly common and usually not related to papilloma. During
pregnancy and lactation, breast tissue grows rapidly and this can lead to duct irritation
that causes bloody nipple discharge or pus. The breasts may also become swollen and warm. This
discharge should not interfere with nursing. If the discharge persists after lactation has
stopped, it should be evaluated further.
Examination for Nipple
Discharge
Women should report any suspicious nipple
discharge to their physicians. A blood test of prolactin levels is
often made to determine hormonal causes of excessive milky discharge (galactorrhea). A
hormone imbalance, pituitary tumor, and certain drugs such as sedatives, tranquilizers,
hormone replacement or birth control pills may cause excessive prolactin levels.
If there is a suspicious nipple
discharge (see above criteria), an examination by a physician should be performed. Clinical breast exam (CBE) is first performed. If a
discharge can be produced during the examination, some of the fluid may be collected and
examined under a microscope to see if any blood cells or cancer cells are present. This
test is called a nipple smear. The discharge may also be examined for signs of infection
such as pus. Papillomas may be seen with microscopic examination of a nipple discharge,
but this test may be inconclusive.
If the discharge is bloody or serous, a
mammogram is often the first test to be performed. Even when no cancer cells are found in
a nipple discharge, it is not possible to rule out breast cancer or other condition such
as papilloma.
If a patient has a suspicious mass
together with nipple discharge, evaluation of the mass should be performed using
mammography, adjunctive imaging and biopsy as necessary. If these tests are negative and
show no malignancy, nipple smear should be evaluated.
Some papillomas are near the nipple and
are large enough to be felt. In these cases, a needle biopsy can be done to test for
malignancy or diagnose papilloma.
In some cases, a galactogram (also called a ductogram) is performed to aid in
diagnosing the cause of an abnormal nipple discharge such as intraductal papilloma.
However, a ductogram that does not show an abnormality does not exclude the fact that a
significant lesion may be present.
Treatment for Persistent
Nipple Discharge
The standard treatment for nipple
discharge that has no hormonal involvement is duct excision. Duct excision is usually
performed on an outpatient basis with local anesthesia. The procedure is usually done
through a small circular incision near the areolar border around the nipple. It is not
uncommon for the pathology found to be so microscopic that it is invisible without the
assistance of a microscope. Typically, nursing ability and nipple sensation are preserved
after duct excision. Breast-feeding in the other breast should have no affect from the
duct excision in the opposite breast.
There is usually not a significant
change in breast size/shape after duct excision since only a small amount of tissue is
removed. There is no evidence of increased future risk of breast cancer from the
procedure. Some suggest that there may be a slight increase in risk of breast cancer for
patients with a papilloma, but this possibly higher risk has nothing to do with the
treatment chosen.
Conclusion:
The above information and statistics
are general guidelines. If you have nipple discharge that is worrisome, please do not
hesitate to contact your physician or healthcare provider about it. However, keep in mind
that most nipple discharge is not caused by breast cancer.
Additional References and Resources:
Updated: March 18, 2008
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