Nipple overflow
Nipple overflow is a common symptom of breast disease and can be divided into physiological overflow and pathological overflow. Physiological overflow refers to lactation during pregnancy and lactation, bilateral nipple overflow caused by oral contraceptives or sedatives, and unilateral or bilateral small amounts of overflow in postmenopausal women. Pathologic overflow refers to intermittent, persistent, from months to years of nipple discharge from one or more ducts on one or both sides in non-physiologic situations.
Etiology
1, mesencephalic diseases or pituitary lesions, such as tumors of the mesencephalon and nearby tissues, prolactin adenoma, pineal tumor, hyperpituitary gland function, acromegaly, etc;
2, endocrine system diseases, such as primary hypothyroidism, adrenal tumors, etc;
3, chest diseases, such as chronic mastitis, chest herpes zoster, etc.;
4, the side effects of drugs, such as chlorpromazine, morphine, reserpine, morpholine, gastric renformation and contraceptives and other hormonal drugs, can cause endocrine dysfunction, stimulate the secretion of prolactin, resulting in breast overflow;
5, local stimulation of the breast and systemic stress, such as frequent playing or sucking of the nipple, severe trauma and other factors, can also lead to a transient increase in prolactin and cause breast overflow.
Clinical manifestations
If the nipple overflow is single nipple overflow, it is mostly associated with the following breast diseases.
1, ductal dilatation of the breast
The first symptom of some patients with this disease is nipple overflow. The color of the overflow is mostly brown, and a few are bloody. This disease occurs in non-lactating or menopausal women over the age of 40. The lumps in the areola area where the discharge occurs are often less than 3 cm in diameter and the ipsilateral axillary lymph nodes may be enlarged, soft and painful to the touch.
2. Intraductal papilloma
This disease is common in people aged 40 to 50 years old, and the tumor mostly occurs in the area adjacent to the nipple, which is very small, with a tip and villi, and many thin-walled blood vessels, so it is easy to bleed. When the patient’s breast is palpated, sometimes a cherry-sized lump can be found under the areola, which is soft, smooth and active.
3, cystic hyperplasia of the breast
It is common in women of childbearing age. Some patients have yellow-green, brown, bloody or colorless plasma-like nipple discharge. This disease has two characteristics: First, it is manifested as periodic swelling and pain in the breast, which often occurs or worsens in the premenstrual period. The second is that breast lumps are often multiple and can be seen on one or both sides, or can be confined to a part of the breast or scattered throughout the breast. The lumps are nodular in shape and vary in size, tough and not hard, with no adhesion to the skin and poorly defined from the surrounding tissues.
4.Breast cancer
Some patients with breast cancer have bright red or dark red nipple discharge and sometimes clear water discharge, colorless and transparent, occasionally sticky, leaving no trace after discharge. 45-49 years old and 60-64 years old are the two peaks of this disease. Patients may unintentionally find breast lumps, mostly located in the upper inner or upper outer limit, painless and progressively larger. In advanced stages, orange peel-like skin changes and satellite nodules appear at the lesion site. The axillary lymph nodes are enlarged, hard and fuse with each other to form a mass as the disease progresses.
Examination
1.Laboratory examination
(1) Overflow cytology is simple, convenient and can detect breast cancer at an early stage, which is an easily accepted diagnostic method.
(2) Needle aspiration cytology examination of lumps with nipple overflow can reach 96% of the correct diagnosis of breast cancer, but the correct diagnosis of benign nipple overflow is lower.
(3) Biopsy is the most reliable method to confirm the etiology of nipple overflow, especially for early microscopic tumor foci, which need further reliable methods to confirm the diagnosis. If puncture biopsy can be performed on the basis of imaging localization, the diagnosis rate can still be improved.
2.Other auxiliary examinations
(1) Near-infrared breast scan This method has a positive diagnostic rate of 80% to 90% for overflow caused by ductal disease in the areola area.
(2) Ultrasound examination This method has a diagnostic compliance rate of up to 80% to 90% for the etiology of benign breast diseases. Ultrasound examination can see enlarged milk ducts, very small cysts, and sometimes intraductal papillomas or filling defect conditions.
(3) Selective ductography has a greater diagnostic value for nipple overflow, benign and malignant breast diseases, especially for those who have nipple overflow without lumps and other signs on physical examination, or whose other tests are negative. Selective ductography can clarify the site, nature and extent of the overflow before the procedure.
Diagnosis
1.Diagnosis of etiology
When diagnosing the etiology of nipple overflow, in addition to detailed medical history and physical examination, careful observation of the type of overflow and whether it is single or multiple duct overflow is required. In addition, relevant auxiliary examinations should be performed to help the diagnosis.
2. Assessment of the amount of overflow
Except for normal milk secretion during pregnancy and lactation, all other nipple overflow is pathological overflow. The assessment of the amount of overflow can be divided into 5 grades. +++: no need to squeeze, natural outflow. ++: filiform squirting out when light pressure is applied. +: 2 to 3 drops flow out when strong pressure is applied. ±: barely visible with strong pressure. -: No overflow visible even with pressure. The amount of nipple overflow assessed after treatment can also be used as a reference for evaluating the effectiveness of treatment.
Treatment
1. Pseudo-overflow
When dealing with nipple overflow, one should first distinguish between true and false overflow. Pseudo-overflow can be treated with appropriate local treatment.
2.Treatment of true overflow
(1) Treatment of non-neoplastic overflow is often caused by ductal dilatation of the breast, cystic hyperplasia of the breast and so on. The former can be treated by medication or surgery, while the latter can be treated by herbal medicine, medication or surgery.
(2) Treatment of tumor overflow is often caused by intraductal papilloma or intraductal papillary carcinoma. In the former, local segmental excision should be performed, and in the latter, radical mastectomy for breast cancer should be performed.