MANAGEMENT of NIPPLE CHANGES

Nipple irritation is not uncommon, but benign causes are usually bilateral. Unilateral itching, irritation, or discharge/bleeding are of more concern.

Discharge that is milky is generally not suggestive of breast cancer and is more likely due to hormonal changes.

Discharge that is clear or yellow can be seen in patients with ectatic ducts or intraductal papilloma, and rarely due to breast cancer.

Discharge that is rusty or bloody is of more concern, but is still most often due to duct ectasia or intraductal papilloma. Ductography can be performed, but is often not required. Ultrasound is the primary diagnostic modality to assess the retroareolar ducts.

flow chart for management of nipple discharge

link to ACR recommendations for nipple discharge

FAMILY MEDICINE CASE 2