Discharge from the nipples is the appearance of discharge from one or both mammary glands. The symptom may be accompanied by pain and discomfort in the chest, redness of the skin over the mammary gland, changes in the areola. The expiration of the secret is observed in inflammatory processes of the mammary glands, benign and malignant tumors, pathologies of the endocrine system. To find out the reasons, ultrasound, mammography, laboratory tests are performed. To alleviate the condition, analgesics can be prescribed, other drugs are used after verification of the diagnosis.
general characteristics
Most often, women themselves notice signs of discharge from the nipples during hygiene procedures, dressing. Often, the discharge looks like droplets of dried secretion in the areolar region, spots on the bra, formed by a small amount of liquid contents of various colors. Sometimes a liquid or thick secret flows out only after pressing on the chest. In some cases, there is a connection between the appearance of a symptom and the phases of the menstrual cycle, sexual intercourse, and the use of hormonal contraceptive methods.
The discharge may have an unpleasant putrid or fetid odor. The symptom is often accompanied by a feeling of heaviness and discomfort in the mammary glands. Sometimes patients notice redness of the breast skin, rashes in the nipple area. Allocations that are not associated with pregnancy and lactation indicate the presence of pathology from the breast or other organs, therefore, in such situations, consultation with a specialist is indicated. Pregnant and lactating women should also consult a doctor if they notice a discharge from the nipples of an atypical color.
Classification
The outflow of liquid secretion from the mammary glands can be both physiological and pathological. Depending on the prevalence of the process, a unilateral and bilateral form is distinguished, according to the conditions of occurrence - spontaneous and caused by breast stimulation. In clinical practice, a classification based on the appearance of the discharge is common, which suggests pathogenetic moments and the root cause of unpleasant manifestations. Based on this criterion, the following types of symptoms are distinguished:
- Colostrum-like discharge (galactorrhea) . The secret in its chemical composition is breast milk, the pituitary hormone prolactin is responsible for its synthesis. The outflow of colostrum from one or two mammary glands is caused by excessive stimulation of the glandular apparatus. An increase in the production of prolactin occurs both with damage to the pituitary gland, and with the indirect effect of various hormonal substances.
- Serous discharge . The clear liquid that flows from the nipples appears as a result of the release of blood plasma from the vessels into the ducts. The symptom may have physiological prerequisites: discharge is occasionally observed during sexual intercourse, when wearing tight bras. The outflow of serous fluid is typical for the initial period of inflammatory processes, light bruises of the chest.
- Green highlights . Thick green discharge consists of desquamated epithelium of the thoracic ducts and single leukocytes. The characteristic coloration is due to the prolonged stagnation of the pathological secretion in the lactiferous passages during their expansion. The symptom may also be associated with the formation of cysts in the breast, in which there is an accumulation of viscous secretion, accompanied by chronic inflammation.
- Purulent discharge . Typical thick yellow-green pus oozes from the nipples in bacterial inflammation. The color of the discharge is associated with the presence of a large number of dead neutrophils (cells that destroy pathogenic bacteria). With different activity of the process, the amount of secretion ranges from a few drops to massive suppuration during the opening of the abscess.
- Bloody discharge . In some cases, the discharge has a bright red or burgundy-brown color, which depends on the age of bleeding. Sometimes ichor flows from the nipple. Blood is released when benign papillomas are injured, malignant tumors decay. After a blow to the chest area, the glandular lobules and ducts are damaged, which is also manifested by bleeding.
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Causes of discharge from the nipples
Causes of colostrum-like discharge from the nipples
Separation of a milky secret from the breast may be due to natural factors, but also occurs with a number of hormonal disorders. The most common causes of colostrum-like discharge are:
- Physiological : pregnancy and breastfeeding period, intense nipple stimulation.
- Consequences of medical, vacuum or surgical abortion .
- Diseases of the pelvic organs : endometriosis, inflammation of the uterus, Chiari-Frommel syndrome.
- Pathology of the hypothalamic-pituitary system: malignant neoplasms, prolactin-secreting pituitary tumors, empty sella syndrome.
- Other endocrine disorders: acromegaly, primary hypothyroidism, Itsenko-Cushing's disease.
- Damage to internal organs: ectopic secretion of prolactin in bronchogenic carcinoma, liver disease, chronic renal failure.
- Complications of pharmacotherapy: taking psychotropic drugs, oral contraceptives, some antihypertensive drugs.
Causes of green discharge from the nipples
Grayish-greenish or green discharge from the nipples is extremely rarely caused by neoplasms. In most cases, their cause is a benign pathology of the mammary glands:
- Milk duct ectasia .
- Mastopathy : fibrocystic form, adenosis of the mammary gland.
- The initial stage of intraductal papilloma .
Causes of purulent discharge from the nipples
A thick yellow or yellow-green secret with an unpleasant odor indicates an acute infectious process. Purulent discharge from the nipples occurs in the following diseases:
- Mastitis: non-lactational, postpartum, galactophoritis.
- Complications of mastitis : breast abscess, fistula formation.
- Infection of the skin around the nipple : boils and carbuncles.
Causes of bleeding from the nipples
Serous-bloody or bloody discharge from the nipple is a serious signal that requires the exclusion of neoplasms of various nature. The most likely causes of a bloody or bloody discharge are:
- Injuries, bruises of the mammary gland .
- Benign formations : intraductal papilloma, fibrocystic changes.
- Malignant tumors : breast adenocarcinoma, Paget's cancer, invasive ductal carcinoma.
Causes of discharge from the nipples in men
Liquid or viscous discharge from the chest in men is formed with the same diseases as in women - traumatic injuries, uncomplicated and complicated mastitis, benign neoplasia, breast cancer, hypothalamic-pituitary dysfunction, etc. The nature of the secret is determined by the disease that provoked its occurrence. With particular caution should be perceived discharge, which appeared for no reason against the background of gynecomastia and is combined with an asymmetric increase in one breast, axillary lymphadenopathy.
Diagnostics
The primary examination of women with complaints of discharge from the nipples is carried out by a specialist mammologist. The doctor selects laboratory and instrumental methods, which are primarily aimed at studying the condition of the mammary glands, identifying suspicious structural changes or signs of inflammation. The following studies have the greatest diagnostic value:
- Ultrasound Scan . With the help of sonography, breast tissue is visualized, structural anomalies, volumetric formations are detected. The method is absolutely safe, therefore it is prescribed even for pregnant women. Ultrasound of the mammary glands is more often used in young women, because their breasts have a dense structure, which is clearly visible during the study.
- Mammography . An x-ray examination of the breast is aimed at detecting neoplasms or fibrous changes that could cause the secretion from the nipples to leak. The method is more informative after 4 years. To clarify the diagnosis, mammography is supplemented with ductography - contrasting the milk ducts.
- Biopsy of the breast . In the presence of a volumetric shadow, a fine-needle biopsy or a trephine biopsy of the mammary gland under the control of an ultrasound device is used. The resulting biopsy samples are sent for cytomorphological analysis to determine the cellular composition and possible signs of malignancy.
- Excretion research . At the expiration of a purulent or turbid serous secretion, sowing of the discharge on nutrient media is indicated. The method is necessary for the identification of a pathogenic agent. In addition, the sensitivity of microbes to antibiotics is studied. Be sure to do a guaiac test, which helps to eliminate bleeding from the chest.
- Blood tests . In addition to standard laboratory tests, when complaining of secretion from the nipples, the level of sex hormones and prolactin in the blood is determined. To exclude neoplasia, a blood test is prescribed for the main tumor markers. Advanced biochemical analysis makes it possible to identify signs of the inflammatory process.
According to the indications, in order to clarify the diagnosis, an MRI mammography is performed. If the discharge from the nipples has an unclear etiology, targeted radiography of the Turkish saddle, CT and MRI of the brain are recommended to exclude pathologies of the hypothalamic-pituitary zone. Taking into account the detected changes, consultations of other specialists (endocrinologist, oncologist) may be required.
Cytology of discharge from the nipple
Treatment
Help before diagnosis
Identification of an unusual discharge from the chest is an indication for seeking medical attention. Attempts to self-medicate can provoke the progression of the disease and serious complications. To reduce discomfort in the chest, which disrupt the quality of life, various analgesics and anti-inflammatory drugs from the NSAID group are used. Patients during lactation who have seen serous or purulent discharge are advised to express milk regularly to prevent lactostasis.
Conservative therapy
Medical tactics depend on the disease that caused the expiration of the secret of the mammary glands from the nipples, the age of the patient, the presence of pregnancy, and extragenital pathology also matter. For treatment, etiotropic and pathogenetic agents are selected. Complex therapy includes medications, physiotherapy methods. The following groups of drugs are most often prescribed:
- Antibiotics . These medicines are used in all cases of bacterial lesions of the breast. At the beginning of treatment, the selection of drugs is carried out empirically, the therapy regimen is usually adjusted after receiving the results of bacteriological culture. Most often, antibiotics from the group of beta-lactams, macrolides are used.
- NSAIDs . Anti-inflammatory drugs are indicated as pathogenetic therapy for mastitis, the consequences of chest injuries. The drugs improve general well-being, eliminate pain, well stop local signs of inflammation. NSAIDs are prescribed with caution in the presence of concomitant diseases of the gastrointestinal tract (ulcers, gastritis).
- Hormonal agents . For the treatment of various forms of mastopathy, antiestrogens are recommended - medicines that reduce the effect of sex hormones on breast tissue and prevent the growth of fibrous tissue. Oral contraceptives are prescribed to reduce the concentration of estrogen, normalize hormonal levels.
- Cytostatics . Chemotherapy drugs are used for malignant neoplasms of the mammary glands as an independent method or as a preparation for surgical treatment. Therapy regimens are selected individually, taking into account the results of cytological and molecular diagnostics. Treatment may be supplemented with radiation therapy.
Surgery
In complicated forms of mastitis, opening and drainage are indicated. If the discharge is caused by benign or malignant tumors, surgery is recommended. Based on the data on the stage of the disease and the histological characteristics of the tumor, different types of surgical operations are prescribed: excision of the fibrous node or cyst, sectoral resection of the mammary gland, lumpectomy. Diffuse changes in the breast, the presence of a malignant neoplasm are indications for radical mastectomy followed by mammoplasty.