What is the meaning of nipple discharge?

Ninety percent of nipple discharge is caused by hormonal changes or by benign or non-cancerous conditions. It is not unusual for a discharge to come from the nipple when the nipple is squeezed or by simply massaging the breast. Discharge may occur after vigorous exercise or sexual intercourse. Discharge may be clear, cloudy, bloody or milky. You should contact your physician if you notice discharge that is occurring spontaneously from one nipple without applying pressure to the breast or nipple.

Is bloody discharge more suspicious than clear, yellow or cloudy discharge?

No! This is a common misconception. Clear, yellow and cloudy discharges – occurring spontaneously from one nipple - have the same risk for being associated with breast cancer. The good news is that 90% of such discharge is associated with benign or non-cancerous conditions.

The most common cause for spontaneous unilateral discharge is a benign papilloma, a non-cancerous growth, resembling a wart within the duct. When detected through ductography, these growths are easily removed by the surgeon with the help of ductogram localization before surgery.

Do I need a ductogram?

When nipple discharge occurs spontaneously (e.g., staining the bra or night gown, appearing on the nipple surface after a hot shower) and appears to come from one duct opening on the surface of one nipple, you should advise your physician who will consider recommending a ductogram. Ductography is a special examination of the milk ducts, performed by the breast imaging radiologist.

What is the significance of inverted or retracted nipples?

Nipple inversion is an indentation of the nipple surface. Nipple retraction is a pulling in of the entire nipple. Nipple inversion is not uncommon. Nipple inversion occurs most commonly during breast development and is not a sign of cancer. If inversion develops over a few months or less, it can be a sign of breast cancer. However, this is more likely the result of a benign (non-cancerous) condition. Nipple retraction may be the result of inflammation or infection involving the milk ducts that converge as they enter the nipple. Some breast cancers may cause these same milk ducts to shorten and pull on the nipple, drawing the entire nipple inward. Changes in the nipples should be reported to your physician.

What is ductography?

Ductography is usually a painless procedure involving the placement of a tiny metal cannula or tube into the duct from which the discharge is coming. A small amount of contrast (iodine-containing fluid which renders the ducts visible on an x-ray) is injected and mammographic images are taken. Abnormalities seen within the ducts may be localized in this manner to aid surgical removal.

Normal Ductogram	Ductogram showing dilated ducts and a benign papiloma (arrow)