Nipple problems

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Abnormal discharge from the nipple	Female breast	Intraductal papilloma	Mammary gland
Normal female breast anatomy

Discharge from breasts; Milk secretions; Lactation - abnormal; Witch's milk; Galactorrhea; Inverted nipple; Nipple discharge

Breast changes that may occur:

• Breast lump or irregularity
• Breast tenderness , swelling, or increased warmth

Changes in the shape of the nipples may include:

• Inverted nipples, in which the nipple is indented into the areola, but will often come out with breast stimulation or during pregnancy
• Retracted nipples, in which the nipple was raised above the surface but begins to pull inward and does not come out when stimulated

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Nipple discharge may be:

• Milky (galactorrhea)
• Clear, bloody, or discolored (green or brown) discharge
• Present only with pressure on the breast or without pressure (called spontaneous discharge)
• Present in one or both nipples

Skin changes around the nipple may include:

• Redness, tenderness, and cracking of the skin surface of the nipple
• Dimples, puckers, or a rash on the skin of the nipple or the areola (darker skin that surrounds the nipple)

The health care provider will take your medical history and perform a physical examination.

Tests that may be done to look for causes of nipple discharge:

• Prolactin level
• Thyroid function tests
• Head CT scan or MRI to look for pituitary tumor

Other tests that may be done include:

• Mammography , performed in all cases
• Ultrasound of the breast
• Breast biopsy if a mass or lump is found, if the mammogram is abnormal, or if the discharge is occurring on its own without any pressure on the breast
• Ductography or ductogram, an x-ray with contrast dye injected into the affected milk duct
• Skin biopsy , if Paget's disease is a concern

Review Date: 11/01/2009
Reviewed By: Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, WA; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).