American Medical Association Family Medical Guide - American Medical Association [573]
Nipple Discharge
A whitish or gray-green discharge just before or after childbirth is likely to be breast milk, especially if it comes from both nipples. If you have a milky discharge at any other time, it is called galactorrhea (see next page), and can be a sign of an underlying disorder. You need not worry if you have nipple discharge only when the nipple is manipulated, such as during foreplay; this is a normal physiologic response.
Any spontaneous nipple discharge, however, should be evaluated by a doctor. Note whether the discharge comes from one nipple duct (one of the tiny holes in the nipples) or from many. If the discharge is dark (usually dark red or black), especially if it comes from only one breast, see your doctor. The dark coloring is usually caused by blood in the discharge, often from a tiny benign growth in the milk duct called a duct papilloma. In rare cases, however, a dark discharge from the nipple could also be a sign of breast cancer.
Your doctor will examine your breasts and may analyze a sample of the discharge. He or she may also recommend other diagnostic tests, including a mammogram (see page 141) and an ultrasound (see page 111). If anything suspicious is found on the mammogram or ultrasound, the doctor will recommend a biopsy, in which a small sample of tissue is removed from the breast for examination under a microscope. If you have a duct papilloma, it can be removed in a simple surgical procedure.
Inverted Nipples
Some women’s nipples are naturally inverted, which is normal for them. The only possible disadvantage of inverted nipples is that they can make breastfeeding more difficult. However, if your nipples are not normally inverted and you notice, especially on only one breast, that a nipple (or any part of your breast) is pulled in, see your doctor. He or she will examine the breast and may order diagnostic tests to rule out breast cancer.
Paget’s Disease of the Nipple
Paget’s disease of the nipple is an uncommon form of breast cancer that starts in the milk ducts of the nipple. Without treatment, the cancer can gradually spread deeper into breast tissues. The disease resembles the skin condition eczema (see page 1062) and usually affects only one nipple. The nipple itches and burns and may have a sore that doesn’t heal.
If you have symptoms of Paget’s disease, your doctor will probably recommend removing a small piece of tissue from the affected breast for examination under a microscope for cancer cells (biopsy). Early detection and treatment are your best chances for a cure. The treatment for Paget’s disease of the nipple is similar to that for breast cancer (see page 857), depending on the extent of the cancer when it is diagnosed.
Breast Abscess
An abscess is an infected, pus-filled area of tissue. A breast abscess forms when bacteria enter the breast through the nipple and infect the milk ducts and glands. Breast abscesses are not common. They can affect any woman, but occur mostly in women who are just beginning to breastfeed (see page 539). During the first week of breastfeeding, the nipples may become dry and develop cracks, making it easier for bacteria from the baby’s mouth to enter the breast.
Symptoms and Diagnosis
An abscess usually develops in the skin around the nipple. As the bacteria multiply, they produce a red, firm, painful swelling or lump in the breast. The glands in the armpit next to the affected breast may be tender, and you may have a fever. Even if you are not breastfeeding, see your doctor right away if you develop any symptoms of a possible abscess. Doctors can usually diagnose a breast abscess from the symptoms.