Definition

Nipple problems can include tenderness or discharge from the nipple portion of the breast. (See also intraductal papilloma.)

Causes, incidence, and risk factors

Nipple tenderness may be caused by inadequate lubricant secretion by the sebaceous glands of the areolar region of the breast or from irritation of the skin from constant excessive moisture that may occur in breastfeeding women. Bacterial or fungal infection of the nipple may also cause nipple tenderness. Tenderness may also result from local trauma or friction over the area.

A milky-appearing nipple discharge may normally occur during pregnancy, shortly after delivery, or in breastfeeding women. It may also be caused by a variety of endocrine disorders.

Chlorpromazine-type drugs and birth control pills may also cause a milky nipple discharge. Abnormal nipple discharge may be caused by breast cancer (least common cause), intraductal papilloma, and mammary dysplasia with ectasia of the ducts (most common cause).

Symptoms

• redness, tenderness and/or cracking of the skin surface of the nipple
• swelling of some portion of the breast (breast lump)
• increased surface temperature of portion of the breast
• nipple discharge
• clear, serous, milky, bloody, or discolored green or brown
• spontaneous or only when pressure is applied to the breast
• involving one or both breasts
• possible breast tenderness

Signs and tests

A careful history and physical examination should be performed.

• Cytological evaluation (cell studies) of nipple discharge may be done in some cases, but it is often of limited value.
• A mammography is usually performed if the cause is not readily evident.
• A breast biopsy is performed if a mass or lump is found, or it the discharge is occurring spontaneously from one duct.

Treatment

Treatment depends upon an accurate diagnosis of the cause. It may range from observation and reassurance, to prescribing medications, to surgery or other treatments.

Support Groups

Expectations (prognosis)

Most causes of nipple problems do not involve breast cancer and can be managed or resolved with adequate treatment.

Complications

A nipple discharge may be a symptom of breast cancer.

Calling your health care provider

Call for an appointment with your health care provider if nipple problems occur.

Prevention

Breastfeeding women should be taught to clean the breasts well before and after feedings and to use breast pads to help maintain dryness between feedings. Breast creams may be used to help keep the nipple area lubricated and supple.

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