Nipple conditions can occur in both women and men. They are usually associated with lactation, inflammation, or hormonal changes. If you notice any changes to your nipple or new onset discharge from your nipples, you should seek medical consultation to figure out the cause.
Most causes of nipple discharge are benign. Although frightening for patients to witness, nipple discharge is very common and usually not cancerous. Up to 50-80 percent of women will experience nipple discharge in their reproductive lifetime. Nipple discharge color can appear clear, bloody, green, gray, or yellowish. Milky discharge is associated with pregnancy or breastfeeding and sometimes persists after breastfeeding ends.
The two most common diagnoses for nipple discharge are duct ectasia and an intraductal papilloma, both benign conditions that should be determined by a clinician. Other causes of nipple discharge are overstimulation of the breast tissue, medication side effects, clogged ducts, infection, or benign growths. If nipple discharge is spontaneous (presents without manipulation of the breast), persistent, comes from a single area in the nipple, clear or bloody in appearance, or associated with an underlying mass, make an appointment with a breast provider so it can be evaluated by clinical breast exam and imaging.
Nipple retraction/inversion can be worrisome. If this is a new change in your nipple appearance, associated with an abnormality on breast imaging, associated with a palpable breast mass, or associated with a new skin change speak to your medical provider immediately. Some individuals are born with an inverted nipple or have long standing nipple inversion. If this is the case or the nipple is easily everted (manipulating the nipple outward) without any other symptoms, the condition is considered normal.
Benign conditions, such as eczema or dermatitis, can present in this fashion and are often the reason for skin changes of the breast. Paget’s disease is a rare, noninvasive cancer which involves the nipple and may indicate that a mass is present within the breast. If necessary, your provider may refer you to a dermatologist for a biopsy of the skin to determine the cause of the skin conditions.
There are underlying nipple conditions that can first present as nipple discharge. The most common lesion to cause nipple discharge is an intraductal papilloma or multiple intraductal papillomas. An intraductal papilloma is a benign mass that develops in the milk ducts. They are common in women from age 35-55 and are made primarily out of gland and fibrous tissue. A rare but easily diagnosed condition is a nipple adenoma. A nipple adenoma presents as a palpable nodule in the superficial layer of the nipple and can sometimes cause an ulcer to form or the skin to look erosive. More prevalent in individuals with nipple piercings and smokers, a subareolar breast abscess forms due to infection and inflammation. Most abscesses respond well to antibiotics plus active drainage of the area either by aspiration or incision and drainage.