Nipple Discharge Evaluation in Gomti Nagar, Lucknow

Nipple discharge is any fluid from the nipple that is not breast milk during breastfeeding. It can be milky, clear, yellow, green, brown or bloody, and thick or watery. It may leak by itself or appear only when the nipple is pressed.

Most causes are harmless. Widened milk ducts that fill with sticky green or brown fluid are common in middle age, often from more than one opening. Hormone changes, an underactive thyroid, high prolactin and some medicines can cause milky discharge from both breasts. A breast infection can cause yellow or green discharge with pain and redness.

A small wart-like growth inside a duct, called an intraductal papilloma, is a common cause of clear or bloody discharge from a single duct. It is usually not cancer, but it needs to be seen on a scan. Less often, discharge is the first sign of a breast cancer, which is why certain types are always checked.

Doctors look at the pattern more than the colour. Discharge is more likely to need tests when it has these features:

• It comes out on its own, without squeezing, and stains your clothes or bra.
• It comes from one breast, and especially from a single opening on the nipple.
• It is bloody, or clear and watery.
• It comes with a lump, a skin change or a change in the nipple, such as turning inward.

Discharge from both breasts that appears only when pressed, or that is milky or greenish from several openings, is far more often harmless. Men can have nipple discharge too, and any discharge in a man should be checked.

Assessment starts with questions and an examination. You are asked how long it has been going on, which side, what colour, whether it comes on its own, and about periods, pregnancy, breastfeeding, thyroid problems and medicines. The breasts, nipples and underarms are then examined.

Imaging depends on age and findings. A breast ultrasound can show a widened duct and any growth inside it, and it is often the first scan in younger women. In older women, or whenever the history or the ultrasound suggests it, a mammogram is added to look for a lump or tiny calcium specks.

If a scan shows something, the next step may be a needle test of that area, such as breast FNAC or a breast biopsy. Normal scans are reassuring, but they are not always the end of the matter. Bloody discharge from one duct that keeps coming back may still need a breast surgeon's opinion, because a very small growth inside a duct can be missed.

If a hormonal cause is suspected, your doctor may ask for blood tests, for example a thyroid test.

Clear or yellowish fluid can leak from the breasts in pregnancy, and milk may keep leaking for months after breastfeeding ends. This is usually normal. Blood-stained discharge in pregnancy or breastfeeding is often caused by the ducts growing and is usually harmless, but it should still be checked, especially if it is on one side or does not stop.

Ultrasound is the usual first scan at these times because it uses no radiation. Tell the team if you are pregnant or breastfeeding when you book.