BN Doctors’ Lounge: Nipple Discharge

Happy new month everyone! Over the last four weeks we have been looking at conditions affecting the breasts and have covered breast self examinations, breast pain, and breast lumps. Today, we will round up and look at nipple discharge and briefly discuss breast shapes and sizes as a response to a reader’s question in week one.

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Nipple Discharge
The nipples are the outlet for the breast glands and during pregnancy, whilst under the influence of female sex hormones, the breast normally produces milk. If the breasts have any other fluid coming out of them, or if milk is produced outside pregnancy, it is termed nipple discharge. Although it is not always abnormal or a sign of disease, all cases of nipple discharge should evaluated by a physician.

Milky white
This is often the most common type of nipple discharge and can be especially alarming in Men. The medical term for milky discharge from the nipple outside pregnancy is galactorrhea (the basic component of breast milk is galactose).
Some brain tumors can cause the breasts of both men and women to produce milk abnormally and these are called Prolactinomas and are situated in the Pituitary gland. These would also be accompanied by headaches and visual difficulties.

Clear
Nipple discharge could also be clear and this is quite common too. In post pubertal women, excessive nipple stimulation, either sexually or caused by rubbing on the area by a bra or t-shirt may produce a clear to slightly milky discharge and is perfectly normal. Certain drugs like some medication taken to treat depression can cause nipple discharge and your doctor will have told you about this while prescribing them. Other causes of clear nipple discharge should be reported to a Physician

Bloody
A reddish discharge from the breast is most often blood or blood like (sero-sanguinous) fluid. Commonly, this is seen after blunt or penetrating injury to the breast or due to some infections or cancers. Bloody nipple discharge is almost always a cause for concern and if you have noticed it please see your doctor immediately.

Coloured (Green, Yellow, Brown)
Coloured discharge is often a sign of infection or abscess and the different colours would depend on the type of bacteria causing the discharge. Breast infections are often caused by skin dwelling bacteria that find their way under the skin into the substance of the breast usually through the nipple. These bacteria are ‘harmless’ when on the skin because of the special protective keratin layer which prevents them from causing any damage, but if they are able to gain access below the skin, (through the nipples in the breast for instance, or through a breach in the epithelium in any other part of the body) then they can readily multiply and form an infected abscess.

A lot of women are religious about the hygiene of their nether regions and will wash briefs and other such intimates daily but are not as meticulous about breast hygiene and may not wash a bra in months. Theoretically, all it takes is one bacterium!

Generally, (but not always) nipple discharge is more likely to be normal if it comes out of both nipples or happens only if you stimulate your nipples. Nipple discharge that is more likely NOT normal is bloody, comes out of only one breast, comes out on its own without stimulation and nipple discharge in Men. There are however a handful of exceptions to these and as a result all cases of nipple discharge should always be evaluated by a doctor to ascertain its cause.

Breast Shapes
In week 1, one of our readers Aibee, asked that we explain the different breast shapes and sizes to help determine what could be considered normal.

Let me reiterate that ALL breast shapes and sizes are perfectly normal.

A British website Bratabase has developed a chart describing the different breast shapes their staff encountered during bra fittings over a six year period.

One thing that is evident at a glance is that there is a wide variety of different breast shapes. While each of these may have different aesthetic value, as long as the functional components of the breasts (the milk glands and ducts as well as the nipple areola complex) are present and healthy, women with any breast shape or size are be able to breast feed their children.

Breast sizes can vary from A* to as H and outside whatever cultural aesthetic value, the size of a woman’s breasts is no longer seen an indicator of her fertility and a more reliable index is the waist to hip ratio. Larger breasts may, however, predispose their owners to postural defects and lower back pain.

In a nutshell
Nipple discharge is possible in both men and women. Whilst some cases are no cause for concern, some might be a sign of serious disease like brain tumors and infections. If you have noticed any discharge from your nipples, please see a doctor.

Did you know?
When a baby is born there can be some milky discharge from the nipples called ‘witches milk’ and is as a result of the mothers hormones that have circulated through the baby’s body via the placenta, which act on the breast glands to produce milk. This discharge usually disappears after a week or so.

Disclaimer: This article is written for patient education. It is not intended to diagnose or prescribe treatment and does not replace the advice of your physician. It in no means attempts to cover the full medical scope of this condition.

Photo Credit: Bratabase, all rights reserved.