Evaluating Nipple Discharge

Nipple discharge is the third most common breast complaint after breast pain and breast mass. It is most often a benign process. Up to 50% women in their reproductive years can express one or more drops of fluid from the breast. Nipple discharge can be of several types, including milky, multicolored and sticky, purulent, clear and watery, yellow or serous, pink or serosanguinous, bloody or sanguinous. The characteristics of the nipple discharge help in the early diagnosis and management of breast disease. The most common cause of pathologic nipple discharge is a benign papilloma followed by ductal ectasia, and the least likely is carcinoma. Most nipple discharges are the result of a clinically insignificant benign process; therefore, less invasive, nonsurgical diagnostic modalities have been explored to reduce the need for surgical intervention. The evaluation and diagnosis of nipple discharge is important for the early detection of carcinoma, when present; and, in the case of benign disease, it is necessary to stop the incommodious discharge. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to state that nipple discharge is not an uncommon complaint; explain that it has multiple etiologies, most of which are benign; and recall that careful history, physical exam, and appropriate use of imaging techniques, cytology, and rarely biopsy are indicated.