Nipple Discharge

Nipple discharge is the discharge of fluid from the breast unilaterally or bilaterally, except during pregnancy and lactation. Nipple discharge can occur normally (physiologically) or it can be a symptom of a wide variety of diseases. Physiological nipple discharge can occur during pregnancy and lactation, as well as as a result of stress, excessive physical exercise, overstimulation of the breast, or irritation caused by an unfitting bra. It may also be associated with menstrual hormone changes and fibrocystic changes. Milky discharge after breastfeeding normally affects both breasts and can persist for up to two or three years after you stop breastfeeding.
Each human breast has between 15 and 20 milk ducts. Nipple discharge may be caused by one or more of these milk ducts. Nipple discharge is the third most common breast complaint after breast pain and breast mass. Nipple discharge can be seen in 50-80% of women of reproductive age. Most nipple discharges are associated with benign diseases (97%). But it needs to be evaluated by a Breast Surgeon to be sure. When there is nipple discharge in men, a physician should be consulted and investigated.
Some women who are worried about nipple discharge may actually be making the problem worse by squeezing the breast while trying to control the discharge. In order to prevent this, it will be useful to leave the breast alone for a while without squeezing and to monitor whether the flow will continue.
It is very important whether nipple discharge is spontaneous (without squeezing the nipple or putting pressure on the breast) or provocative (after squeezing the nipple or applying pressure to the breast). Nipple discharges that are considered pathological are spontaneous discharges. In addition, this type of discharge usually originates from a single breast. This type of nipple discharge is often caused by a benign breast disease.
However, it should not be ignored that it may also be associated with breast cancer, especially in the following cases:
Patients older than 40 years,
If the current is one-sided,
If it happens spontaneously,
If it is clear like water or bloody,
If the mass accompanies,
Possible causes of pathological nipple discharge are:
Galactorrhea: It is the milk coming out of the breast outside the pregnancy and lactation period. Since the discharge has the appearance of milk, it is not difficult to distinguish it from other causes. It is a spontaneous discharge from both breasts and many ducts. It is caused by an increase in the hormone Prolactin secreted from the pituitary gland. This increase may develop due to a prolactin-secreting adenoma in the pituitary gland. Some drugs can also cause high prolactin. These include oral contraceptives (birth control pills), hormonal drugs used in hormone replacement therapy, anti-nausea drugs, antidepressants, and drugs used to treat psychiatric disorders. In addition, some herbs such as anise and fennel and stimulants such as cocaine and marijuana can also cause high prolactin levels.
Intraductal papilloma: They are benign, wart-like lesions that develop in the milk duct, usually close to the nipple. It may cause a clear or bloody nipple discharge. It is the most common cause of bloody nipple discharge. The discharge is usually unilateral and originates from a single channel. It is sometimes detectable by breast ultrasonography, but can be difficult to diagnose safely with needle biopsy. Its treatment is the surgical removal of the milk duct in which it is located.
Ductal ectasia (Ductal ectasia): It is a benign condition in which the milk ducts under the nipple are enlarged and there is inflammation in the walls of the ducts. It is one of the most common causes of spontaneous nipple discharge. The discharge caused by duct ectasia is usually yellow, green, or brown, coming from both breasts and more than one duct. In most cases, no treatment is needed. If the discharge is bothersome, the ducts behind the nipple can be surgically removed.
Fibrocystic changes: In addition to causing pain and itching, fibrocystic breast changes can occasionally cause the secretion of clear, white, yellow or green colored nipple discharge. The discharge is usually from both breasts.
Breast cancer: It is one of the rare causes of nipple discharge. Less than 5% of women with breast cancer have nipple discharge, and many of these women also have other signs of breast cancer in addition to nipple discharge, such as a mass, breast skin depression, or newly developed nipple retraction. Discharges due to breast cancer are usually dark colored and unilateral discharges because they are bloody or contain blood.

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