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There are many causes of nipple discharge, only a few are related to a serious illness. The color and texture of the secretions that come out of the breasts are important. Is it white, red, green? It is also important whether the nipple discharge affects both mammary glands and whether the woman is pregnant, postmenopausal, or has hormonal disorders.

Nipple leakage is a disturbing symptom, especially for women who are not pregnant or lactating. Although also in this case - when a woman is expecting a baby or after giving birth - you need to carefully observe the type and color of the fluid that comes out of the nipple.

There are times when fluid leakage from the nipple occurs before your period, or in postmenopausal women, discharge comes out of one or both breasts. The doctor (gynecologist or surgeon, or family doctor) will ask about all of this before making a diagnosis. Check what are the possible causes of breast leakage.

Sometimes the doctor asks for hormonal examinations, breast ultrasound, mammography, biopsy.

Pregnancy - milk discharge from the breast

Nipple discharge may appear when a woman becomes pregnant. During 9 months of pregnancy, the entire mammary gland will undergo numerous changes, including anatomical ones, thanks to which it will be possible to produce food for the baby after delivery.

The nipples will become more sensitive, they will bulge and darken. The strands of the veins will become more visible under the skin on the chest. This is due to estrogens that dilate the blood vessels. In both breasts, the blood will circulate more intensively to activate the glands and milk ducts. In many future mothers, food appears at the end of pregnancy. It's colostrum - it is released spontaneously, most often at night.

Important.During pregnancy and lactation, normal breast secretion is milky in color and comes out of both glands.

puerperal abscess - thick yellow nipple discharge

The puerperal nipple abscess may be the cause of the appearance of a thick yellow discharge from the breasts. It occurs in women in the perinatal period, this problem affects 2-3% of breastfeeding women. A breast abscess may appear at any stage of lactation, but most often between the 2nd and 6th week after giving birth. More often in the winter than in the summer months. Nipple abscessesThey are more often observed in white women than black and Asian women.

The cause of an abscess in the breast is a bacterial infection. Most often it develops as a complication of untreated or poorly treated milk duct obstruction (e.g. through strenuous massage).

Symptoms.If a puerperal abscess forms, it is accompanied by pain, swelling, redness, hardening and excessive warming of the gland. The lymph nodes in your armpit can also be painful. Occasionally the symptoms may be accompanied by fever and chills. There is a soft, painful lump in the breast and a purulent discharge from the nipple. The mammary gland may be partially or completely inflamed.

Treatment.The most important therapeutic activity is frequent emptying of the breasts. The best way to do this is to properly suckle your baby. If your baby does not suckle in the same rhythm as before, use the breast pump to empty the breasts. After feeding, cold compresses will bring relief.

Improvement is generally achieved within 24 hours. Your doctor may advise you to take anti-inflammatory and analgesic medications, and if appropriate, give you an antibiotic for 10-14 days.

Non-infertile breast abscess - thick yellow fluid

Purulent discharge from the nipple may be related to the appearance of an abscess and inflammation of the breast beyond the puerperium. Each diagnosed case of a breast abscess should be differentiated from a milk cyst, but above all from an inflammatory or non-inflammatory breast tumor, including breast cancer.

The best imaging test to diagnose a breast abscess is ultrasonography. Thanks to this examination, it is possible to determine whether there is one or more abscess foci in the breast.

Before starting treatment, it is also important to know whether a single or multi-chamber abscess has formed in the breast. Worse, the problem may recur. Sometimes it is necessary to excise the inflamed tissue and pass it for histopathological examination in order to exclude neoplastic changes.

List of factors that increase the risk of a nipple abscess in non-lactating women:

  • general weakening of the body, decreased immunity,
  • diabetes,
  • taking steroid drugs,
  • procedures performed within the mammary gland,
  • period after or during breast radiotherapy,
  • stress and exhaustion,
  • pressure on the breasts (e.g. by wearing too tight underwear),
  • malnutrition,
  • smoking.

Galactorrhea - hyperprolactinemia

Galactorrhea caused by hyperprolactinemia canrecognize both in women (who are not pregnant, lactating) and in men. In this case, milky discharge from the nipple indicates a disturbance in the hypothalamic-pituitary system, which results in disturbed secretion of prolactin, a hormone that stimulates milk production (lactation).

If a woman of childbearing age develops milky discharge from her breasts, a pregnancy test should be done first. A negative result may indicate hyperprolactinaemia / hormonal imbalance is the cause of white breast discharge. Your doctor will refer you to test your prolactin and TSH levels. If an elevated level of prolactin is found, hyperprolactinemia is diagnosed.

In the case of women and men, we distinguish hyperprolactinemia:

  • Physiological- when the cause of excessive prolactin secretion and discharge from the nipples is stress, excessive exercise, hypoglycaemia.
  • Pathological- caused by a disease, e.g. pituitary adenoma, head trauma, inflammatory or neoplastic changes (e.g. in the hypothalamus and pituitary gland), in the course of kidney failure or liver, or hypothyroidism (elevated TSH levels). Increased prolactin levels and milky nipple discharge may also result from medication.

Treatment.It depends on the cause causing the increased secretion of prolactin and most often consists in the chronic use of drugs that inhibit the secretion of this hormone. In some cases, surgery is necessary. In drug induced hyperprolactinaemia, it is usually sufficient to stop taking the medication causing the disorder (e.g., an antidepressant, antiemetic, antihypertensive, antihistamine).

Lesions - light or blood-colored discharge

Some symptoms may indicate that nipple discharge is related to pathological changes. The fluid may be clear (serous) or blood-colored. Consider whether the leakage is in one or both breasts. It is also important whether the leakage occurs permanently, from time to time, only after pressing the entire breast or the nipple itself.

Check if there are any lumps or enlarged lymph nodes in the armpits in the breasts. The appearance of the nipple itself, whether it is pulled in or distorted, is also important. The cause of nipple leakage may be intraductal papilloma, dilated output ducts, breast cancer.

Important.If there is a serous or blood-stained discharge from the nipple, see your doctor. Necessaryyou will perform tests - mammography or breast ultrasound. If, despite nipple leakage, no suspicious foci are detected by imaging examinations, galactography (mammography with contrast medium) or resonance imaging (MRI) of the mammary gland may be performed.

bow. Andrzej ZmaczyƄski, specialist in gynecology and obstetrics, Sublimed Medical Center in Krakow

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