Discharge from the nipple is one of the most distressing breast symptoms — even when it is completely benign. Up to 80% of women experience some form of nipple discharge in their lives. The colour, the side, whether it comes spontaneously or only with squeezing, and whether one duct or many are involved — these features tell us almost everything we need to know.
When discharge is reassuring
Discharge is usually benign when it is:
- •From both breasts
- •From multiple ducts
- •Yellow, green, brown or grey
- •Only appears when the nipple is squeezed
- •Linked to hormonal changes, pregnancy, breastfeeding or recent stopping of breastfeeding
Red-flag features
Discharge that warrants investigation:
- •Blood-stained or clear watery discharge
- •From a single duct
- •From one breast only
- •Spontaneous (you wake up with stains in your bra)
- •Associated with a lump
- •In a postmenopausal woman
Common causes
**Physiological** — hormonal, pregnancy, post-breastfeeding. Bilateral, multi-duct, no other features. **Galactorrhoea** — milky discharge in a non-breastfeeding woman. Caused by raised prolactin (medications, prolactinoma, hypothyroidism). **Duct ectasia** — dilated ducts in older women, thick yellow/green discharge, often with retracted nipple. **Intraductal papilloma** — small benign wart-like growth inside a duct, classic cause of single-duct blood-stained discharge in women aged 35–55. **Periductal mastitis** — infection/inflammation in smokers, often with abscess. **Breast cancer** — rare cause of discharge but always considered when discharge is bloody, unilateral and from a single duct.
Investigations
- •Detailed history and examination — chaperoned
- •Ultrasound of the breast and behind the nipple
- •Mammogram if over 40 or suspicious features
- •Discharge cytology (rarely conclusive)
- •Ductogram or MRI for single-duct bloody discharge
- •Prolactin and TSH blood tests if galactorrhoea
Treatment
Most cases need only reassurance and lifestyle advice (avoid squeezing, supportive bra, treat thrush or eczema if present).
Galactorrhoea — treat the cause (review medications, treat low thyroid, refer to endocrine for prolactinoma). Duct ectasia — supportive measures; surgery only for severe symptoms. Intraductal papilloma — microdochectomy (single-duct excision) under day-care general anaesthetic. Mastitis/abscess — antibiotics ± drainage.
When to book
See a surgeon promptly if you have: blood-stained discharge, single-duct discharge, spontaneous discharge, postmenopausal discharge, or any associated lump.
Book Dr Vanesha at Medcare Al Safa via Okadoc or WhatsApp +971 58 500 4596.