Experiencing fluid in the breast, often called nipple discharge, can be concerning. While sometimes alarming, it is common and can affect women of all ages, including those not pregnant or breastfeeding, and even men. Understanding the different types of fluid and their origins is important for informed health decisions.
Understanding Different Types of Breast Fluid
The characteristics of breast fluid, such as color and consistency, offer clues about its cause. While many instances of nipple discharge are harmless, some types warrant closer medical attention.
Milky Discharge (Galactorrhea)
Milky discharge, or galactorrhea, is milk-like fluid from the breast not associated with pregnancy or breastfeeding. It typically appears white, but can also be yellowish or greenish. It often originates from both breasts and may occur spontaneously or when the nipple is stimulated.
Galactorrhea commonly results from elevated levels of prolactin, a hormone produced by the pituitary gland that stimulates milk production. Causes of increased prolactin include hormonal imbalances, such as those seen in hypothyroidism (an underactive thyroid) or certain medications like antidepressants, antipsychotics, and some blood pressure drugs. Physical stimulation of the nipples, such as during sexual activity or from tight clothing, can also trigger this type of discharge. In some cases, a benign tumor on the pituitary gland, called a prolactinoma, can lead to excessive prolactin production.
Clear, Yellow, or Greenish Discharge
Clear, yellow, or greenish nipple discharge can be associated with several common benign breast conditions. Fibrocystic breast changes, involving fibrous tissue and cysts, are a frequent cause. These changes can lead to lumps, pain, and sometimes discharge.
Duct ectasia, where milk ducts become inflamed and blocked, is another common reason for thick, greenish, or sticky discharge, especially in women approaching menopause. Hormonal fluctuations can also contribute to clear or colored discharge. Clear discharge from only one breast can be a sign of a papilloma (a non-cancerous growth in a milk duct) or, less commonly, breast cancer.
Bloody or Brown Discharge
Bloody or brown discharge from the nipple requires medical evaluation. This type of discharge can be caused by intraductal papillomas, benign, wart-like growths within the milk ducts. These growths can become inflamed, leading to discharge.
Duct ectasia can also result in reddish-brown or dark brown discharge. Bloody or clear discharge, especially if from one breast, can be a symptom of breast cancer. Paget’s disease of the breast, a rare form of breast cancer involving the nipple, can also cause bloody discharge.
Pus-like Discharge
Pus-like discharge from the breast indicates an infection, such as mastitis or a breast abscess. This discharge often appears yellow and may have a foul smell. Mastitis, an inflammation of the breast tissue, is common in breastfeeding women but can also occur in those not lactating.
Accompanying symptoms of a breast infection include pain, redness, warmth, swelling, and sometimes fever. The infection occurs when bacteria, such as Staphylococcus aureus, enter the breast tissue through a break in the skin. An abscess, a collection of pus, may form in severe infections and might require drainage.
When to Consult a Healthcare Professional
Knowing when to seek medical advice for breast fluid is important for timely diagnosis and management. Certain characteristics of nipple discharge indicate a need for professional evaluation.
Consult a healthcare professional if the discharge is spontaneous (occurs without squeezing or stimulation). Discharge from only one breast or a single milk duct is also concerning. These unilateral discharges often indicate a localized issue within that breast.
Any bloody, brown, or pus-like discharge requires a medical visit. These types are abnormal and often associated with conditions needing prompt attention. If discharge is accompanied by other symptoms like a new breast lump, pain, redness, skin dimpling, or nipple changes (e.g., inversion or scaling), consult a doctor. Persistent discharge, even if benign, also warrants medical evaluation.
Diagnosis and Treatment Approaches
When evaluating breast fluid, a healthcare professional identifies the cause through a diagnostic process. This begins with a thorough medical history and physical breast examination. The doctor will ask about the discharge’s characteristics, duration, and any associated symptoms.
Following the initial examination, several diagnostic tests may be employed. A mammogram and an ultrasound are common first-line imaging tests used to visualize breast tissue and detect abnormalities. Magnetic Resonance Imaging (MRI) is also used, particularly if initial imaging is inconclusive, due to its high sensitivity in detecting breast malignancies. More specific tests like ductography (galactography), which involves injecting a contrast dye into milk ducts, or a biopsy, where a tissue sample is taken, may be performed if a suspicious area is identified.
Treatment for breast fluid depends on the diagnosis. For benign conditions, observation may be sufficient, or medication might be prescribed for hormonal imbalances, such as those causing galactorrhea. If an infection is present, antibiotics are administered. For certain benign growths, like intraductal papillomas, or in cases of malignancy, surgical removal of the affected duct or tissue may be recommended.