Nipple overflow is not a separate disease, but a symptom of the disease. Many diseases will have nipple overflow, but of course, more often than not, the overflow is just a physiological phenomenon. In fact, many women have nipple overflow, except that normally the overflow does not run out on its own and needs to be squeezed to flow out of the nipple, so many people do not notice it.
Generally speaking, the most common diseases associated with nipple discharge are intraductal papilloma and ductal dilatation (or plasmacytosis), and some patients with mastopexy also have discharge. Some patients with breast enlargement also have overflow. Among breast cancer patients, nipple overflow is not the most common.
What is nipple overflow?
In general, there are several aspects to determine the condition of overflow: the nature of overflow, the number of overflow ducts, the amount of overflow, and the accompanying symptoms of overflow.
1, the nature of the overflow. This includes the following cases: (1) bloody overflow, (2) colorless plasma overflow (clear water-like overflow), (3) yellow plasma overflow, (4) tan, coffee-colored overflow (5) milk-like overflow (6) purulent overflow (7) grease-like overflow, etc.
(1) Hemorrhagic overflow: This is the most important condition to be dealt with actively. The common disease is intraductal papilloma or breast cancer, which undoubtedly requires surgical treatment. However, there are exceptions. Clinically, it is common to see young women who are pregnant or just entering breastfeeding suddenly present with fresh blood or old blood accumulation from the nipple, like coffee color. Patients are very nervous because of this. In fact, this situation does not matter, most of the bleeding is caused by the epithelial shedding of the ducts, the bleeding is large, it will quickly overflow from the milk ducts, that is, fresh blood; bleeding is small, it will stay in the breast for a few days, and then squeezed out is black blood. This situation can be observed for a few days is often fine and does not require any treatment.
(2) Clear water-like overflow: This is the most tangled type, and in most cases it is physiological or just a manifestation of breast enlargement. However, there are also patients with breast cancer who have clear water-like overflow. In this case, we need to see whether the overflowing duct is single or multiple, if it is multiple, it is usually not important; if it is single, the amount is more, or even accompanied by lumps, then we need to take it seriously.
(3) Yellow plasma overflow: It is the most common kind of overflow that can appear in various breast diseases, especially in patients with breast hyperplasia. Some of them are also intraductal papilloma or breast cancer. Still, it is important to pay attention to single breast duct overflow.
(4) Tan and coffee colored overflow: This type is most often seen in intraductal papilloma and breast cancer, especially in the former. Of course, as already mentioned, young mothers or mothers-to-be can observe the situation for a few days and then check further if the situation does not improve.
(5) Milk-like overflow: This kind of overflow usually does not require mammography treatment. If it is porous overflow, it is mostly a physiological situation during breastfeeding, late breastfeeding, after miscarriage, etc.; it is also common to take medications, such as morpholine as a representative of stomach medication, blood pressure medication as a representative of rifampin, psychiatric medication as a representative of chlorpromazine, etc. Of course, there are also pathological conditions: hyperprolactinemia, pituitary microadenoma. These two diseases are usually treated by neurology and endocrinology and do not require a visit to the mammography department. If it is a single hole overflow, there is usually nothing to worry about and no special treatment is needed, regular follow-up is sufficient.
(6) Purulent overflow: It is not common clinically, and is usually seen in patients with ductal dilatation (plasmacytoid mastitis). Whether you have fever or not, this condition is to be actively treated.
(7) grease-like overflow: this condition is mostly ductal dilatation (plasmacytoid mastitis), which needs to be actively treated, otherwise the lesion will expand and form an untreated lesion.
2, the number of overflowing ducts: in general, single-hole overflow is more meaningful than multi-hole overflow and requires more treatment. Single-hole overflow is mostly due to diseases such as papilloma and breast cancer in the breast ducts; multi-hole overflow is mostly physiological, drug side effects, also seen in pituitary tumors, systemic diseases, mastopexy and other diseases.
3, the amount of overflow: the amount of overflow is not as meaningful as the previous two, and it cannot be said that more overflow is more meaningful than less overflow.
4, the accompanying symptoms of overflow: there is no doubt that those accompanied by lumps, local redness and swelling are symptoms that need to be actively dealt with in breast surgery. If porous overflow is accompanied by headache and menstrual irregularities, it is necessary to go to gynecology to see if there are polycystic ovaries and to neurology to see if there are pituitary tumors.
Second, the examination methods of nipple overflow
1, clinical examination: that is, the clinician’s visual examination and palpation, do not underestimate this article, most of the overflow is found in the clinical examination.
2.Smear examination of overflow: it can find the shed tumor cells. However, because there are few tumor cells in the overflow, the positive rate of this examination is very low.
3.Ultrasound examination: It can detect dilated ducts and tiny occupancies in ducts, which is helpful for the diagnosis of intraductal papilloma.
4.Mammography: This test is not for papillary overflow, but is used to determine whether the overflow is accompanied by microcalcifications, occupancy and other accompanying signs.
If there is a tumor in the duct, the contrast agent will not fill the lumen, which is called “filling defect”, and if the tumor is large, it will completely block the duct and form a “cup and mouth” sign.
6.Lactoscopy: Compared with the previous non-invasive examinations, this examination is still a bit painful. During the examination, a lens made of optical fibers is inserted into the overflowing duct. The ducts at the back of the nipple are like tree roots that get finer and finer, which requires the lens to be inserted along these branches for inspection, and each branch that may be diseased should be looked at. This examination also has a therapeutic effect, as the ducts can be flushed clean of dilated, inflamed ducts while looking at them. If a tumor is seen, the diagnosis is even clearer.
7.Blood test for prolactin: This test is specifically for those patients with overflowing breasts, especially porous overflow, and is used to diagnose the presence of hyperprolactinemia.
8. Surgical removal of the diseased duct: This is the last resort, not only for examination, but also for treatment. Surgery must be performed when the nipple overflow or the above mentioned tests reveal a tumor; when all tests fail to make a clear diagnosis, many times surgery is also required.
Nipple overflow needs to be integrated with many situations to make a judgment. We should pay full attention to single hole, bloody, coffee-colored and greasy overflow. It is important to analyze the specific problem in order not to miss the diagnosis or over-treat it.