Alternative names

Discharge from breasts; Milk secretions; Lactation – abnormal; Witches milk; Galactorrhea

Definition

This symptom involves abnormal discharge from the nipple(s)

Considerations

The likelihood of nipple discharge increases with age and number of pregnancies.

While a milky nipple discharge is rare in men and in women who have never been pregnant, it does occur. When it does, it is likely to be caused by some underlying disease, particularly when accompanied by other changes in the breast(s).

It is relatively common in women who have had at least one pregnancy. A thin yellowish or milky discharge (colostrum) is normal in the final weeks of pregnancy.

The nature of the discharge can range in colour, consistency, composition, and may occur on one side or both sides.

“Witch’s milk” is a term used to describe nipple discharge in a newborn. The discharge is a temporary response to the increased levels of maternal hormones. Witch’s milk should disappear within 2 weeks as hormone levels dissipate in the newborn.

Other nipple discharges can be bloody or purulent (containing pus), depending on the cause.

Common Causes

• Breast abscess (most common in lactating women)
• Trauma can cause discharge from both breasts
• Drugs such as cimetidine, methyldopa, metoclopramide, oral contraceptives, phenothiazines, reserpine, tricyclic antidepressants, or verapamil
• Prolactinoma (prolactin-secreting tumour in the brain)
• Intraductal papilloma (a small noncancerous growth in the duct of the breast)
• Ductal ectasia

Home Care

Follow provider-prescribed therapy.

Call your health care provider if

If there is any abnormal nipple discharge, call your healthcare provider.

What to expect at your health care provider’s office

The medical history will be obtained and a physical examination performed.

Medical history questions documenting a nipple discharge in detail may include:

• Are you pregnant?
• Are you breastfeeding?
• What type of drainage is there?
  • Does it look like milk (even though you are not breastfeeding)?
  • Does it look bloody?
  • Does it look like pus?
• Is the drainage from both breasts?
• How much drainage is there?
  • Enough to stain the lining of the bra?
  • Enough to soak through the bra?
  • Does the discharge occur spontaneously, or only when expressed?
• Do you perform breast self-examination? How often?
• What medications do you take?
• What other symptoms are also present? Especially is there:
  • Fever
  • A breast lump
  • Breast pain
  • Headaches or change in vision

The physical examination will include an examination of the breasts for lumps or other abnormality.

Diagnostic tests that may be performed include:

• Breast biopsy (if lump is found)
• Cytologic study of discharge (a study of the cells in the discharge)
• Head CT scan to look for pituitary tumour
• Mammography
• Serum prolactin
• Transillumination (a light is placed against the breast to help determine if there is an accumulation of fluid in the tissue)
• Ultrasonography (ultrasound of the breast)

Attitudes about women’s breasts have always been influenced by fashion trends. In the Twenties, women bound their breasts; in the Forties, more volume was desirable; then, in the Sixties, a less restricted look was popular. Contemporary styles reflect a trend toward fuller, yet natural-looking lines. But regardless of your breast size, all healthy breasts have the same basic anatomy. When you’re considering breast reduction, it helps to know your anatomy so you can make informed choices with your surgeon’s guidance.

Breast tissue is made up of glands that produce milk during pregnancy.

Fat provides protective padding for the milk-producing glands.

The areola is the pigmented tissue that surrounds each nipple.

Chest muscles contract and expand so you can move your arms.

The rib cage houses vital organs like your heart and lungs.

The Inframammary fold is the crease where your chest wall meets your breast.

Once a breast lump or breast abnormality has been detected, your doctor may want to conduct a breast biopsy. This procedure involves taking sample tissue from the suspicious area to determine whether the breast lump is cancerous.

While the thought of having a breast biopsy might be frightening, the results can provide reassuring peace of mind. Remember, the vast majority of breast biopsies do not turn out to be breast cancer. And a biopsy is currently the only way to achieve an accurate breast cancer diagnosis.

There are various breast biopsy options to consider. The choices range from an open surgical procedure to new minimally invasive techniques. Be sure to understand your biopsy options and talk with your doctor to determine the procedure that is best for you.

There are two methods for producing images in minimally invasive breast biopsies:

1. Stereotactic
2. Ultrasound guided

Stereotactic biopsy

Stereotactic [STARE-ee-o-TAK-tik] biopsies use mammography (x-rays) to locate breast abnormalities, while ultrasound biopsies use high-frequency sound waves to create breast tissue images.

In a minimally invasive breast biopsy using stereotactic imaging, a patient lies face down on a special table with her breast protruding through a hole in the table’s surface. The breast is lightly compressed to immobilize it throughout the biopsy procedure. The table is connected to a computer that produces detailed x-ray images of the abnormality to be biopsied. Using these images, the doctor guides a special sampling device (for example, biopsy probe) to collect tissue specimens.

Ultrasound-guided biopsy

Minimally invasive breast biopsies using ultrasound imaging are performed on patients in an upright or reclined position. Using a hand-held transducer, a doctor will move the device back and forth across the breast to generate clear images of the abnormal breast tissue.

While viewing the images on a computer monitor, the doctor will guide a small probe into the breast to retrieve sample tissue specimens.

Core Needle Breast Biopsy

In a core needle biopsy, the physician makes a small skin incision through which a needle is inserted into the lesion to obtain sample tissue. The hollow spring-loaded device is “fired” repeatedly into the abnormality to collect a sufficient amount of breast tissue for analysis. Usually, 4 to 6 samples are taken (4 to 6 insertions). This biopsy procedure is performed in an outpatient setting or doctor’s office without general anesthesia or stitches.

Fine Needle Aspiration Breast Biopsy

Fine Needle Aspiration (FNA) is a biopsy procedure that uses a thin needle on a syringe to draw fluid and/or cellular material from a breast abnormality. Thus, Fine Needle Aspiration provides information about cellular material, whereas the other tissue biopsy procedures allow tissue within the abnormality to be compared to surrounding tissue for a more accurate diagnosis. Fine Needle Aspiration is most often used to aspirate, or drain fluid, from benign (non-cancerous) fluid-filled cysts. However, the extracted fluid can be examined by a pathologist to confirm whether the abnormality is benign or requires further testing.

Fine Needle Aspiration biopsy procedures are generally performed by a physician in his or her office. If the breast lump is small and cannot be felt, the procedure can be performed using stereotactic or ultrasound imaging guidance. During the procedure, a long, thin needle is inserted through the breast into the abnormality for sample extraction. Because the needles used for Fine Needle Aspiration biopsies are smaller than needles used to draw blood, local anesthesia is not required.

Why should I be concerned about breast cancer?

It seems like we’ve all been affected by breast cancer at some point in our lives, whether we have had it, or have had a family member or friend who’s battled it. Every woman has a chance of getting breast cancer. Other than skin cancer, breast cancer is the most common cancer in American women and the disease we fear most. As scared as we are, you can try to remember that if you find breast cancer early, it can often be treated successfully. Many women have overcome breast cancer and are living life to its fullest!

Where can I learn more about breast cancer?

For More Information…

National Cancer Institute
Cancer Information Service
Tel: (800) 422-6237
Website: www.cancer.gov

National Breast and Cervical Cancer Early Detection Program
Tel: (888) 842-6355 (select option 7)
Website: www.cdc.gov

American Cancer Society
Tel: (800) ACS-2345
Website: www.cancer.org

Susan G. Komen Breast Cancer Foundation
Tel: (800) 462-9273
Website: www.komen.org

The goal of screening exams for early breast cancer detection is to find cancers before they start to cause symptoms. Screening refers to tests and examinations used to detect a disease, such as cancer, in people who do not have any symptoms. Early detection means applying a strategy that results in an earlier diagnosis of breast cancer than otherwise might have occurred.

Breast cancers that are detected (found) because they are causing symptoms tend to be relatively larger and are more likely to have spread beyond the breast. In contrast, breast cancers found during screening exams are more likely to be small and still confined to the breast.

The size of a breast cancer and how far it has spread are the most important factors in predicting the prognosis (the outlook for chances of survival) of a woman with this disease. Finding a breast cancer as early as possible greatly improves the likelihood that treatment will be successful. There is no question that early detection tests for breast cancer save many thousands of lives each year, and that many more lives could be saved if even more women and their health care providers took advantage of these tests.

Breast Cancer screening includes a Breast Self Examination, Breast X-ray (mammogram) and professional physical examination.

Alternative names

Mastitis; Infection – breast tissue; Breast abscess

Definition

This infection is located in the tissue of the breast. In most cases, bacteria entered the tissue through cracks in the nipples.

Causes, incidence, and risk factors

Breast infections are usually caused by a common bacteria found on normal skin (Staphylococcus aureus). The bacteria enter through a break or crack in the skin, usually the nipple.

The infection then takes place in the parenchymal (fatty) tissue and causes swelling of the parenchymal tissue outside the milk ducts. This swelling compresses on the milk ducts, and the result is pain and swelling of the infected breast.

Breast infections usually occur in women who are breastfeeding. Breast infections that are not related to breastfeeding must be differentiated from a rare form of breast cancer.

Symptoms

• breast pain
• breast lump
• breast enlargement on one side only
• swelling, tenderness, redness, and heat in breast tissue
• nipple discharge (may contain pus)
• nipple sensation changes
• itching
• tender and/or enlarged lymph nodes in armpit on the same side
• fever

Signs and tests

In women who are not breastfeeding, testing may include mammography or breast biopsy. Otherwise, tests are usually not necessary.

Treatment

Self-care may include applying moist heat to the infected breast tissue for 15 to 20 minutes four times a day.

Antibiotic medications are usually very effective in treating mastitis. You are encouraged to continue to breastfeed or to pump to alleviate engorgement while receiving treatment.

Support Groups

The stress of an illness can often be helped by joining a support group in which members share common experiences and problems. See breastfeeding – support group.

Expectations (prognosis)

The condition usually clears quickly with antibiotic therapy.

Complications

In severe infections, an abscess may develop. Abscesses require more extensive treatment, including incision and drainage. Discontinuation of breast-feeding may be recommended in this case.

Calling your health care provider

Call your health care provider if any portion of the breast tissue becomes reddened, tender, swollen, or hot, or if the lymph nodes in the armpit become tender and/or enlarged.

Prevention

Good breast care, especially after delivery and while breast-feeding, may decrease the potential to develop breast infections.

Alternative names

Pain – breast; Mastalgia; Mastodynia; Breast tenderness

Definition

Breast pain involves any discomfort or pain in the breast, such as premenstrual tenderness.

Considerations

There are many possible causes for breast pain. For example, hormonal fluctuations related to menstruation or pregnancy are often responsible for breast tenderness. Some degree of swelling and tenderness just before your period is normal. The question is how tolerable (or intolerable) the discomfort is to you.

Although many women with pain in one or both breasts understandably fear breast cancer, breast pain is NOT a common symptom of cancer.

Boys and men have breast tissue. If a male has breast tissue that is visible, this is called gynecomastia. As a normal part of development, adolescent boys can have some breast swelling and tenderness. Like breast tenderness in women, this is due to hormonal changes.

Common Causes

Some degree of breast tenderness is normal, caused by hormonal fluctuations from:

• Menstruation
• Pregnancy — tends to be more common during the first trimester and pregnancy at a young age
• Puberty — in both girls and boys
• Breastfeeding
• Approach of menopause (once your menstrual periods have stopped completely, breast tenderness often goes away unless you are taking hormone replacement therapy)

Soon after childbirth, your breasts may become engorged with milk. This can be very painful and is usually accompanied by swelling. If you also have an area of redness, call your healthcare provider.

Other common causes of breast pain include:

• Fibrocystic breast changes
• Mastitis — a blocked and infected milk duct that may have some redness, usually associated with breastfeeding
• Premenstrual syndrome (PMS)
• Alcoholism with liver damage
• Injury

Fibrocystic breast tissue is a common condition. It involves breast lumps and bumps throughout the breast tissue that tend to be more tender just before your menstrual period.

Certain medications may also cause breast pain, including digitalis preparations, aldomet, aldactone and other potassium-sparing diuretics, anadrol, and chlorpromazine.

Shingles can lead to pain felt in the breast if the painful blistering rash appears on the skin over one of your breasts.

Home Care

For tips on how to manage pain from fibrocystic breasts, see breast lumps.

Talk to your doctor about possibly taking birth control pills. These can help relieve pain.

If you have a breast infection, you will need antibiotics. Look for signs of infection like localized redness, nipple discharge, or fever. Contact your doctor if you have these signs.

Just after an injury to the breast occurs, apply a cold compress such as an ice pack (wrapped in a cloth — don’t apply directly to the skin) for 15 to 20 minutes. Take a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen to reduce the likelihood of developing persistent breast pain or swelling.

Call your doctor if you have:

• Discharge from your nipples, especially blood or pus
• Given birth within the last week and your breasts are swollen or hard
• Signs of a breast infection, including localized redness, pus, or fever
• Noticed a new lump associated with the pain that does not go away after your menstrual period
• Persistent, unexplained breast pain

What to expect at your health care provider’s office

Your health care provider will perform a breast examination and ask questions about your breast pain, such as:

• How long have you had the symptoms?
• Are one or both of your breasts affected?
• Do you have any nipple discharge?
• Do you perform breast self-examination?
• Have you noticed any lumps or anything unusual when you examine your breasts?
• When was your last mammogram?
• What other symptoms are present? Do you have a fever?
• What medication are you currently taking?

Diagnostic tests that may be performed include the following:

• Breast biopsy
• Culture of nipple discharge to test for infection
• Cytology (microscopic evaluation) of nipple discharge
• Mammography
• Fine needle aspiration — a small needle is inserted into the breast to remove fluid that may have collected in a cyst (usually not cancerous)

Treatment may include the following:

• Pain relievers may be prescribed
• Changes to your diet may be suggested
• Certain medications may be changed or discontinued

Your health care provider should schedule a follow-up visit in case the symptoms have not resolved in a given period of time. He or she may recommend consultation with a specialist if the symptoms do not go away or if you have a complicated condition.

Prevention

Wear a well-fitting brassiere for support, especially if your breasts are large.

Perform a monthly breast self-exam 3-5 days after your period (when the breast tissue is the least tender). This is important to feel for any changes in your breast tissue. If you detect any change from the previous month, it is important to notify your doctor.

Why should I do a breast self-exam?

Regular breast self-exam can help you know how your breasts normally feel and look, so you can notice any changes. When you find a change, you should see your healthcare provider. Most breast changes or lumps are not cancerous, but only a health care provider can tell you for sure. When breast cancer is found early, you have more treatment choices and a better chance of recovery. So, it is important to find breast cancer as early as possible.

Breast self-exam should not take the place of getting regular mammograms. Right now, mammograms are the best way to find breast cancer early and to improve your chances for survival.

What am I looking for when I do a breast self-exam?

You are looking for a lump or change that stands out as different from the rest of your breast tissue. If you find a lump or other change in your breast, either during breast self-exam or by chance, you should examine the other breast. If both breasts feel the same, the lumpiness is probably normal. As you get to know your breasts better by doing breast self-exams, you should be able to tell the difference between your normal lumpiness and what may be a change.

Besides a lump or swelling, other changes in your breast might be

• Skin irritation or dimpling
• Nipple pain or retraction (turning inward)
• Redness or scaliness of the nipple or breast skin
• A discharge other than breast milk

If you see any of these changes, you should see your health care provider right away.

Is there a right way to examine my breasts?

Yes. There are several proper ways to examine your breasts. Ask your health care provider to teach you how to do a breast self-exam to make sure you are doing it correctly and thoroughly. Medline Plus also provides a document that shows the right way to examine your breasts. Click here to visit their website.

Remember that you should discuss any new lump or change with your health care provider.

How often should I do a self-exam?

A breast self-exam is recommended every month a few days after your period ends. During this time, your breasts are less tender or swollen. It is important to do your breast self-exam at the same time every month.

Source: American Academy of Family Physicians AAFP

What is gynecomastia?

Gynecomastia is a condition in which firm breast tissue forms in males. The breast tissue is usually less than 1-1/2 inches across and is located directly under the nipple. Gynecomastia may be present on one side or on both sides. This condition may make the breast tender.

Some men and boys have fat on their chests that makes it look like they have breasts. This condition is called pseudogynecomastia (false gynecomastia). It is not the same thing as gynecomastia.

What causes gynecomastia?

Gynecomastia is usually caused by changes in hormones at puberty or as part of aging. Hormones are chemicals produced by the glands of the body, such as the thyroid gland, the testes, and the ovaries. Gynecomastia may be caused by changes in the balance of 2 hormones, estrogen, and testosterone. In rare cases, gynecomastia is caused by prescription drugs, over-the-counter medicines, illegal drugs, tumors or disease.

Are tests needed to find the cause of gynecomastia?

Sometimes tests are needed, and sometimes they’re not. Your doctor will ask you questions about your symptoms, such as how long you’ve had the breast tissue, and whether or not the area is tender. Your doctor will also ask you about the illnesses you have had in the past, the medicines you take, and other matters relating to your health. Then you will have a physical examination.

Whether you need tests depends on your age and what your doctor learns from your history and physical examination. If you are a teenager, you probably will not need more tests, since gynecomastia is common in teenage boys. As many as 65% of 14-year-old boys have gynecomastia. The breast enlargement usually goes away on its own in 2 or 3 years. However, younger boys and adult men with gynecomastia may need to have some tests, because it is possible that some kind of disease is causing the problem.

How is gynecomastia treated?

In most cases, no treatment is needed. Your doctor will probably want to check the size of your breast tissue every few months. In 90% of teenage boys, gynecomastia goes away in less than 3 years.

Sometimes the problem can be solved if you stop taking a medicine that is causing gynecomastia or stop using an illegal drug that is causing the problem.

Occasionally, medicines may be used to treat gynecomastia, especially if tenderness is a problem. The medicine will make the extra breast tissue go away. Rarely, surgery may be necessary to remove the extra breast tissue.

Treatment is necessary if gynecomastia is caused by a disease or a tumor. If it is due to a disease, the disease itself will need to be treated.

Could the breast lump be cancer?

Probably not. Breast cancer is very rare in males. Your doctor will probably be able to tell whether the lump is cancer. Lumps caused by cancer are usually not underneath the nipple, but breast tissue from gynecomastia grows in this area. Breast cancer feels different than the breast tissue of gynecomastia. With cancer, there sometimes is dimpling of the skin or a bloody discharge from the nipple. If there is any question that you have cancer, you will need to have a mammogram and a biopsy.

What is a mammogram?

A mammogram is a test that is done to look for any abnormalities, or problems, with a woman’s breasts. The test uses a special x-ray machine to take pictures of both breasts. The results are recorded on film that your health care provider can examine.

Mammograms look for breast lumps and changes in breast tissue that may develop into problems over time. They can find small lumps or growths that a health care provider or woman can’t feel when doing a physical breast exam. Breast lumps or growths can be benign (not cancer) or malignant (cancer). If a lump is found, a health care provider will order a biopsy, a test where a small amount of tissue is taken from the lump and area around the lump. The tissue is sent to a lab to look for cancer or changes that may mean cancer is likely to develop. Finding breast cancer early means that a woman has a better chance of surviving the disease. There are also more choices for treatment when breast cancer is found early.

Are there different types of mammograms?

There are two reasons mammograms are taken. Screening mammograms are done for women who have no symptoms of breast cancer. Diagnostic mammograms are done when a woman has symptoms of breast cancer or a breast lump. Diagnostic mammograms take longer than screening mammograms because more pictures of the breast are taken.

In January 2000, the FDA approved a new way of doing mammograms, called digital mammography. This technique records x-ray images on a computer, rather than film. It can reduce exposure to radiation, allow the person taking the x-ray to make adjustments without having to take another mammogram, and takes pictures of the entire breast even if the denseness of the breast tissue varies.

Are mammograms safe?

A mammogram is a safe, low-dose x-ray of the breast. A high-quality mammogram, along with clinical breast exam (exam done by a professional health care provider) are the most effective tools for detecting breast cancer early.

How is a mammogram done?

You stand in front of a special x-ray machine. The person who takes the x-rays (always a woman) places your breasts (one at a time) between two plastic plates. The plates press your breast and make it flat. You will feel pressure on your breast for a few seconds. It may cause you some discomfort, feeling like squeezing or pinching. But, the flatter your breasts, the better the picture. Most often, two pictures are taken of each breast – one from the side and one from above. The whole thing takes only a few minutes.

How is a mammogram done in a woman with breast implants?

If you have breast implants, be sure to tell your mammography facility that you have them. You will need an x-ray technician who is trained in x-raying patients with implants. This is important because breast implants can hide some breast tissue, which could make if difficult for the radiologist to see breast cancer when looking at your mammograms. For this reason, to take a mammogram of a breast with an implant, the x-ray technician might gently lift the breast tissue slightly away from the implant.

How often should I get a mammogram?

Women over 40 should get a mammogram every 1 to 2 years. This guideline was just re-issued by the federal government’s U.S. Preventive Services Task Force. And, it is also the position of the Secretary of the U.S. Department of Health and Human Services. Women who have had breast cancer or breast problems, or with a family history of breast cancer may need to start having mammograms at a younger age or more often. Talk to your health care provider about how often you should get a mammogram. Be aware that mammograms don’t take the place of getting breast exams from a health care provider and examining your own breasts.

If you find a lump or see changes in your breast, talk to your health care provider right away no matter what your age. Your health care provider may order a mammogram for you to get a better look at your breast changes.

Where can I get a mammogram?

Be sure to get a mammogram from a facility certified by the Food and Drug Administration (FDA). These places must meet high standards for their x-ray machines and staff. Check out the FDA’s web site on the Internet at: www.accessdata.fda.gov for a list of FDA-certified mammography facilities. Some of these facilities also offer digital mammograms.

Your health care provider, local medical clinic, or local or state health department can tell you where to get no-cost or low-cost mammograms. Also, call the National Cancer Institute’s toll free number 1-800-422-6237 for information on no-cost or low-cost mammograms.

How can I get ready for my mammogram?

First, check with the place you are having the mammogram for any special things you may need to do before you go. Here are some general guidelines to follow:

• Make your mammogram appointment for one week after your period. Your breasts hurt less after your period
• Wear a shirt with shorts, pants, or a skirt. That way you can undress from the waist up and leave your shorts, pants, or skirt on when you get your mammogram
• Don’t wear any deodorant, perfume, lotion, or powder under your arms or on your breasts on the day of your mammogram appointment. These things can make shadows show up on your mammogram

Are there any problems with mammograms?

As with any medical test, mammograms can have limits. These limits include:

• Mammograms are only part of a complete breast exam. If they show abnormalities your health care provider will follow-up with other tests
• False negatives can happen. This means everything may look normal, but cancer is actually present. False negatives don’t happen often. Younger women are more likely to have a false negative mammogram than are older women. This is because the breast tissue is denser, making cancer harder to spot
• False positives can happen. This is when the mammogram results look like cancer is present, even though it is not. False positives are more common in younger women than older women

This FAQ was adapted from mammography fact sheets from the National Cancer Institute.