Adam M. Brufsky, MD, PhD, is a Professor of Medicine at the University of Pittsburgh who has specialized in breast cancer medical oncology for over 20 years.
Nipple discharge (fluid from the breast) is typical during pregnancy and breastfeeding. More than 80% of people with female hormones have nipple discharge at some point. It can happen at any time to anyone—even those with male hormones.
Nipples can excrete fluid for many reasons. You may be concerned about cancer or precancerous conditions. But rest assured, nipple discharge isn't typically cause for alarm.
This article talks about types of nipple discharge, symptoms, causes, and what to expect from diagnosis and treatments.
Nipple discharge can vary in a number of ways. Its qualities can provide clues to the possible causes.
Nipple discharge changes depending on your stage of life, such as whether you're:
Discharge may occur suddenly and on its own or only when you squeeze the breast or nipple. It may be:
It comes in many colors:
Nipple discharge may occur on one side (unilateral) or on both sides (bilateral). It may come from a single breast duct or multiple ducts.
If you have symptoms along with discharge, they can be clues to the cause. For example:
Some of the conditions that cause discharge may also cause breast pain.
Nipple discharge is common. Anyone can get it. It's more common during times of hormonal fluctuation.
Its appearance, consistency, and color provide clues to what's causing it. Other clues are whether it comes from one breast or both, and one duct or many. Other symptoms provide useful information as well.
Many things can cause breast discharge. Unilateral discharge is more likely with underlying conditions such as:
Bilateral discharge is more likely due to hormonal changes or systemic (body-wide) conditions, such as thyroid disease.
Discharge from a single duct is more likely due to a local condition affecting the breast.
Some of the more common causes include:
Other causes are more serious and may need to be treated.
Mastitis is a breast infection. It may cause:
If the discharge is also foul-smelling, it may be due to an abscess in the nipple or under the areola (pigmented area around the nipple). An abscess is an area the body "walls off" to keep an infection from spreading.
Mammary duct ectasia means blocked milk ducts. It's most common near menopause (perimenopause) or after menopause. The breast ducts widen and become clogged with thick discharge.
The condition may lead to mastitis. This can cause the nipples to turn inward (nipple inversion), raising breast cancer concerns.
Mammary duct ectasia usually goes away in time. Hot packs can relieve any discomfort. Some cases require surgery.
Conditions like mammary duct ectasia and cancer become more common during perimenopause and after menopause. Don't dismiss symptoms and be sure your healthcare provider does thorough testing.
A milky discharge can occur in anyone, regardless of sex or age. It resembles breastmilk and is called galactorrhea .
This is most often due to increased levels of prolactin. That's a hormone involved with breast growth and breastfeeding. This condition is called hyperprolactinemia.
Hyperprolactinemia can also make your periods stop (amenorrhea). In biological males, nipple discharge may be the first symptom.
High prolactin levels can come from many causes:
Some causes of nipple discharge are nothing to worry about. Those include pregnancy, irritation, or medications. Other causes—like infection, duct ectasia, and galactorrhia—may need to be treated.
Intraductal papillomas are benign growths that usually involve a single duct. They're most common during premenopause.
They often cause a clear or bloody discharge. You may notice a painless lump on the nipple.
Most aren't a concern. But some may contain regions of papillary carcinoma of the breast. That's a precancerous condition called ductal carcinoma in situ (DCIS).
While rare, sometimes nipple discharge is caused by breast cancer. It can be an early warning sign of breast cancer that is still in the pre-invasive stage (DCIS). That's more likely in someone over age 40 and/or if:
Discharge from breast cancer can be bloody, clear, or milky.
Paget's disease of the breast is an uncommon form of breast cancer. It accounts for less than 3% of cases.
It usually takes a biopsy to diagnose this condition.
Growths in the breast can cause nipple discharge. Intraductal papillomas are benign. Breast cancer and Paget's disease of the breast are malignant (cancerous).
Breast cancer can impact anyone, no matter the sex. Male breast cancer is often under-recognized, even among healthcare providers.
If you're biologically male and have nipple discharge, see your healthcare provider. They may order a mammogram.
Nipple discharge is often an early warning sign of pre-invasive cancer. This is important to remember. Male breast cancer is often diagnosed in later stages than in females. And that makes it harder to treat.
Another reason to not overlook male nipple discharge is that it could be due to elevated prolactin levels. And that can be caused by a pituitary microadenoma (small tumor).
Those are easier to recognize in females because they can make you skip periods. In males, it can go unrecognized until the tumor affects vision by pressing on the optic nerve.
In newborns, small amounts of clear or milky nipple discharge is fairly common. It may occur with some breast swelling or a small lump. This is related to hormones leftover from pregnancy.
Later in infancy, bloody discharge may occur. It's usually due to mammary duct ectasia.
Biological males may have nipple discharge from breast cancer or high prolactin levels. Breast cancer in males is often diagnosed at later stages.
Newborns may have discharge due to leftover hormones or mammary duct ectasia.
Your healthcare provider will order tests to diagnose nipple discharge. The specific ones depend on your age, symptoms, and what they find during a physical exam. They include:
If breast cancer is a possibility, a breast MRI, ultrasound, biopsy, and a mammogram may all be considered.
The treatment options for nipple discharge depend on the cause. Some causes, such as discharge in later pregnancy, don't need to be treated.
When it does, treatment may include:
Nipple discharge from breast cancer often occurs when the tumor is still very small. Catching it early makes it highly curable.
Nipple discharge can occur in anyone. They're more common around hormonal events like pregnancy and menopause.
The nature of the discharge and other symptoms provide clues to the cause. Some aren't cause for concern. Others may be very serious.
Blood tests, several types of imaging, and an examination of the fluid may be used to diagnose it. Treatment depends on the cause.
Breast cancer is often a concern when there's nipple discharge. Keep in mind that it's more likely to be something else and may not even point to a medical condition.
Both for your health and peace of mind, though, you should get it checked out. The diagnosis may take some time. But it's important to stick with the process even if symptoms appear to go away.
If you're not getting answers, consider a second opinion. Symptoms are our body's way of alerting us to potential problems. It's important to listen.
It can be. Changes to the breasts early in pregnancy can include itchiness, a feeling of fullness, and nipple discharge.
Yes, hormonal changes brought on by your natural cycle or birth control can cause a milky discharge.
Yes, this is normal and is related to the changing hormones across the monthly cycle.
It's not that common. Other benign (innocent) health conditions are more likely to cause nipple discharge. These include a change in hormones or a common infection like mastitis that can happen while breastfeeding.
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