Nipple overflow is a common symptom of breast disease and can be divided into physiological overflow and pathological overflow. Physiological overflow refers to the phenomenon of 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. Pathological overflow refers to intermittent, persistent, from months to years of nipple overflow from one or more ducts on one or both sides under non-physiological conditions. Etiology 1, mesencephalic disease 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 adenoma, etc.; 3, departmental diseases, such as chronic mastitis, chest herpes zoster, etc.; 4, side effects of drugs, such as chlorpromazine, morphine, reserpine, morpholine, gastrofacial The side effects of drugs, such as chlorpromazine, morphine, rifampicin, promethazine, gastrofluan, and hormonal drugs such as birth control pills, can cause endocrine dysfunction and stimulate prolactin secretion, resulting in breast overflow; 5. Local stimulation of the breast and systemic stress reactions, such as frequent playing with or sucking on the nipple, severe trauma and other factors, can also lead to a transient increase in prolactin and trigger breast overflow. Clinical manifestations If the nipple overflow is single nipple overflow, it is mostly related to the following breast diseases: 1. Ductal dilatation of the breast Some patients with this disease have the first symptom of 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, intramammary duct papilloma This disease is common in 40-50 year olds, the tumor mostly occurs in the area adjacent to the nipple, the tumor 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 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 overflow, sometimes clear water overflow, colorless and transparent, occasionally sticky, leaving no trace after overflow. 45-49 years old and 60-64 years old are the two peak incidence 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 site of the lesion. The axillary lymph nodes are enlarged, hard, and fuse with each other to form a mass as the disease progresses. Laboratory examination (1) Cytological examination of overflow is simple and convenient, which can detect breast cancer at an early stage and is an easily accepted diagnosis 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 discharge, 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. (1) Near-infrared breast scan: The positive diagnosis rate of overflow caused by ductal disease in the areola area can reach 80%-90%. (2) Ultrasound examination This method has a diagnostic rate of 80%-90% for the etiology of benign breast disease, and ultrasound examination can reveal enlarged milk ducts, very small cysts, and sometimes intraductal papillomas or filling defects. (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 mammography can clarify the site, nature and extent of the overflow before surgery. Diagnosis 1. Etiological diagnosis 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 should be performed. 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 overflows are pathological overflows. 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. +: 2-3 drops flow out when strong pressure is applied. ±: barely visible with strong pressure. -: No overflow visible even with pressure. Assessment of the amount of nipple overflow 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. (1) Treatment of non-neoplastic overflow is often caused by ductal dilatation and cystic hyperplasia of the breast. 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. The former should be treated by local segmental resection, while the latter should be treated by radical mastectomy for breast cancer.