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. 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 disease or pituitary lesions, such as tumors of the mesencephalon and nearby tissues, prolactin adenomas, pineal tumors, hyperpituitarism, acromegaly, etc.
2, endocrine system diseases, such as primary hypothyroidism, adrenal tumors, etc.
3, diseases of the chest, such as chronic mastitis, herpes zoster of the chest, etc.
4, side effects of drugs, such as chlorpromazine, morphine, reserpine, morpholine, gastrofacial and hormonal drugs such as contraceptives, which can cause endocrine dysfunction and stimulate prolactin secretion in the body, 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 mental 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 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 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.
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 rate of 80% to 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 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 even with pressure. The amount of nipple overflow assessed after treatment can also be used as a reference to evaluate the effectiveness of treatment.
Treatment
What kind of ductal overflow requires surgery? Certainly a combination of the following needs to be considered.
The following conditions tend to preclude surgery: multiple ductal overflows on a single breast, overflows on both breasts, no associated swelling, clear yellow-green-white colorless, longer than 3 years, increased during or slightly after menstruation, clearly related to certain medications, previous surgical confirmation of hyperplastic disease for the same condition, and regular (every 6-12 months or so) observation can be guaranteed.
The following cases are favored for surgery: single hole overflow on a single breast, single breast overflow, with associated swelling, red washed flesh water-like, relatively short period of less than 1 year, previous surgical confirmation of papilloma or severe atypical hyperplasia in the same case, no condition for regular (every 12-24 months) observation. Patients who insist on surgery.
1. Pseudo-overflow
When dealing with papillary overflow, the distinction between true and false overflow should be made first. Pseudo-overflow is feasible with corresponding 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 case, local segmental excision is performed, while in the latter case, radical mastectomy should be performed.
This is not a technical problem, but a conceptual problem: some doctors like to say “can I cut it down” – that can, ductal resection is not a highly sophisticated technology, although it is not easy to do the standard, but it is always not too difficult; however, I think it is more important to The post-operative scar is a permanent reminder for the patient, so don’t leave it unless it is necessary, and don’t do it easily.
First, you need to see what kind of situation you fit into. If there are risk factors in the initial screening, you need to see your doctor for surgery, and if there are obviously no risk factors, you don’t need surgery. If it is between the two possibilities, then you need to see a doctor to identify it.