Sx - Nipple Discharge

Causes of nipple discharge

Physiological	During breast feeding
Galactorrhoea	Commonest cause may be response to emotional events, drugs such as histamine receptor antagonists are also implicated
Hyperprolactinaemia	Commonest type of pituitary tumour Microadenomas <1cm in diameter Macroadenomas >1cm in diameter Pressure on optic chiasm may cause bitemporal hemianopia
Mammary duct ectasia	Dilatation breast ducts. Most common in menopausal women Discharge typically thick and green in colour Most common in smokers
Carcinoma	Often blood stained May be underlying mass or axillary lymphadenopathy
Intraductal papilloma	Commoner in younger patients May cause blood stained discharge There is usually no palpable lump

Assessment of patients

Examine breast and determine whether there is mass lesion present

All mass lesions should undergo Triple assessment.

Reporting of investigations

Where a mass lesion is suspected or investigations are requested these are prefixed using a system that denotes the investigation type e.g. M for mammography, followed by a numerical code as shown below:

1	No abnormality
2	Abnormality with benign features
3	Indeterminate probably benign
4	Indeterminate probably malignant
5	Malignant

Management of non malignant nipple discharge

Exclude endocrine disease

Nipple cytology unhelpful

Smoking cessation advice for duct ectasia

For duct ectasia with severe symptoms, total duct excision may be warranted.