Nipple discharge is one of the more common symptoms of breast disease and may also be one of the clinical manifestations of many diseases throughout the body. There are many reasons for nipple discharge, both physiological and pathological. During pregnancy and lactation, the mother will experience physiological lactation due to the regulation of her own hormones. During non-pregnancy and non-lactation periods, fluid flowing out of the nipple when squeezed is called nipple discharge, which is a pathological overflow.
Nipple discharge can be bloody, plasma blood, plasma, watery fluid, or milk-like. When combined with infection, it can also be purulent. Nipple discharge can be caused by a variety of diseases, so we consider nipple discharge to be an early sign of breast disease.
Therefore, it is important to be alert to nipple discharge and not to take it lightly. The nature of the overflow and the condition of the overflow should be carefully observed. The common conditions of nipple discharge are described as follows.
I. Is the overflow real or pseudo?
True overflow refers to the flow of fluid from the ducts of the breast. Pseudo overflow is common in those with sunken nipples, as the epidermal cells of the nipple accumulate in the sunken area, causing a small amount of liquid-like bean curd-like exudate, often with a foul odor. Once you pull out the sunken nipple and keep it locally clean, the “overflow” will disappear.
Second, is the overflow physiological or pathological?
Bilateral overflow may be physiological, such as within a year of stopping breastfeeding, most women still have a small amount of milk secretion; in the middle and late stages of pregnancy, some pregnant women can squeeze out a little light colored colostrum from both breasts; these are physiological conditions, not pathological. Nipple overflow can also be pathological, such as amenorrhea-overflow breast syndrome.
Third, is the overflow single or multiple holes?
The nipple has 15-20 openings for the milk ducts. When overflow occurs, it is important to observe from which one or several openings the fluid is spilling. A single-hole overflow is most often an intraductal papilloma. Porous overflow may be physiologic, pharmacologic, systemic benign disease, or mastopexy.
Fourth, is the overflow spontaneous or after squeezing?
The former is mostly pathological, and about 13% of breast cancer patients have a history of spontaneous overflow. Benign or physiological overflow is more common after squeezing.
V. What are the characteristics of overflow?
Different breast diseases have different traits when it comes to overflow. For example
(1) Milk-like: mostly physiological, such as recent after weaning or miscarriage, not a manifestation of cancer.
(2) Purulent overflow, mostly ductal dilatation and plasmacytoid mastitis.
(3) Pale yellow overflow is the most common type of overflow and is seen in almost all kinds of breast diseases, with mastopexy being the most common. Some are also intraductal papillomas or breast cancer. Therefore, this is something to be vigilant about.
(4) Bloody overflow, which can be of different colors such as bright red, coffee, yellowish or brown. This kind of overflow is a danger sign and should be highly alerted.
(5) Clear watery overflow, which is colorless and transparent, occasionally sticky, and leaves no trace after overflow. This kind of overflow may be a sign of breast cancer and should be further examined.
VI. Age
The importance of nipple overflow varies with age. Generally, younger patients tend to have a preference for benign disease. If nipple discharge occurs after the age of 50, it should be highly suspected as a malignant disease.
In conclusion, nipple overflow is an important breast symptom, and symptoms should be seen in a timely manner. The most accurate examination method for diagnosing intraductal lesions is mammography, which has greater value in the differential diagnosis of benign and malignant nipple overflow, and it can also provide physicians with accurate positioning of the scope of surgical excision.