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Nipple Discharge

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  • Elijahgirl
    Elijahgirl Member Posts: 111
    edited February 2018

    I just had my biopsy on Monday and this evening I had a lot of blood oozing from my nipple, I have had bleeding from this nipple before my biopsy but this moore than the usual norm. Should I be concerned?

  • djmammo
    djmammo Member Posts: 1,003
    edited February 2018

    Elijahgirl

    Bloody discharge from the nipple can be seen after such a biopsy as the needle crosses a duct. The growth in the duct that causes bloody discharge is extremely vascular and that can add to the bleeding. Sometimes if there is a hematoma or other post biopsy collection it can drain through the ducts for quite a while. You cannot lose enough blood to be harmful to you. The bleeding will certainly stop when you have the surgery to remove the biopsy target.

  • AC719
    AC719 Member Posts: 1
    edited February 2018

    Ok so for the last 3.5 years I have had nipple discharge like milk on my right breast and I have seen my GYN about it twice. This most recent time was this past Wednesday. He wanted to do a smear of it but it wouldn't do it at the doctor office. My mother is concerned afraid this is cancer and he is blowing it off. What do I say to my doctor to make him do further testing?

  • MaggieCat
    MaggieCat Member Posts: 315
    edited February 2018

    DJ - I had some crust on my left nipple two weeks ago. When squeezed a small amount of relatively milky liquid - I'd say from one duct. No discharge from other breast. I just checked and was able to express a very small amount of white-ish milky discharge from left breast, same duct. Have had itching in the nipple during this time. Haven't been too concerned other than the itching keeps me aware of the breast. Latest imaging 11/2017 - "stable". Should I be concerned?

  • djmammo
    djmammo Member Posts: 1,003
    edited February 2018

    MaggieCat

    See my post a few paragraphs above dated Jul 29, 2017 07:43AM

  • Love27
    Love27 Member Posts: 1
    edited February 2018

    hi DJ,

    You responded to my post on worries. I’ve gone for an mri and I am waiting for result. Since I have had prolactin, hormone, thyroid and para thyroid all come back clear, I’ve had only clear discharge in one breast from one duct with pain. But only when I squeeze. If my mri comes back noWhat else could it be? What other test should I ask for?

  • djmammo
    djmammo Member Posts: 1,003
    edited February 2018

    Love27

    The ductogram is the gold standard for evaluating nipple discharge of this kind. You may have to call around to find a center that does them often enough to do them well.

    Click Here for more information

  • NSwrites
    NSwrites Member Posts: 4
    edited March 2018

    Hi DJMammo - my ductogram (galactogram - same thing, right?) was not able to be completed (other details in a comment above - one duct, one breast, brownish black). The radiologist could not get into the duct. My general practicioner says we don't need to do any followup. I pushed because I disagree, and he has referred me to a general surgeon. Any thoughts on whether a galactogram should try to be repeated when they can't get the needle into the duct, or what other tests might figure this out?

  • djmammo
    djmammo Member Posts: 1,003
    edited March 2018

    Love27

    Clear and bloody discharge are the types 2 we worry about. The MRI is very sensitive and can pick up very small abnormalities. If there is something bad there it should show up. If not and the discharge persists the next two choices are a ductogram or surgical duct exploration

  • djmammo
    djmammo Member Posts: 1,003
    edited March 2018

    NSwrites

    I usually bring pts back for at least one additional attempt at the ductogram after a week, making sure the pt doesnt try to express any fluid that whole time. Then hot towels on the breast for a while before trying again. We used a very bright light and magnifying lenses. After that an MRI if you have not had one yet

  • NSwrites
    NSwrites Member Posts: 4
    edited March 2018

    That makes sense. Thanks, Djmammo. I was able to express fluid at the appointment but they couldn't get the needle in. Perhaps the cold room played a factor. My doctor will not send me back for another one, nor for an MRI. I will push to see a specialist.

  • ConfusedZee
    ConfusedZee Member Posts: 2
    edited March 2018

    DJ - I recently had a spontaneous nipple discharge from my left Breast which was clear. I did a self exam and noticed an indentation on the lower part of the left Breast when my arms are raised. I had a scare 6 years ago, but it was a lump that turned out to be fibrocystic breasts. I have an appt with my obgyn Monday. What questions should I ask and should I persist for MRI?

  • djmammo
    djmammo Member Posts: 1,003
    edited March 2018

    Tinydaisey7

    I would see a doc at your first opportunity, either PCP, ObGyn, etc. doesn't matter who, just anyone who can examine your breasts and order some imaging. There are agencies in most states that will help with these kinds of expenses for people without insurance. Do this soon. Make sure you tell them about the nipple discharge in the past too.

  • djmammo
    djmammo Member Posts: 1,003
    edited March 2018

    ConfusedZee

    Clear and bloody are the two colors of discharge we worry about, though bloody more so. You should ask what they think is causing the discharge, but your doc will ask most of the questions like when it started, is it one sided, is it spontaneous, has there ever been any blood. May also ask you about current medications.

    At this point I don't think insurance will pay for an MRI until mammo & ultrasound are performed. Papillomas are usually what causes breast discharge of the type described above and they can often be well seen and biopsied on US. If it cannot be located on US then I personally prefer a ductogram to an MRI for this but then again I have done so many of them (they are falling out of favor since they can be time consuming and it gets difficult to find someone who does them frequently enough). If the culprit is only a few millimeters in size it will be difficult to distinguish from all the other tiny white dots that make up an MRI of the breast.

    Let us know what your doc says.

  • Deema_0
    Deema_0 Member Posts: 1
    edited March 2018

    after reading through this thread im super anxious. i now noticed that my right nipple has a clear to yellowish discharge when squeezed and it seems to be more than the left. Is this something I should go back to the dr for? Had a clear ultrasound in September and just met with breast surgeon in February. Scheduled for annual with my gyn in may. (Side note: I have major health anxiety!!)

  • djmammo
    djmammo Member Posts: 1,003
    edited April 2018

    Deema_0

    If this is a new symptom for you, your doctor(s) need to know about it and have the opportunity to request imaging for it. The cause of the discharge is often a very small growth in a duct that cannot be seen on routine mammograms. A careful US search is the first step in evaluation of nipple discharge. If you haven't read my inital post in this thread, go back and read that now for additional information.

  • ConfusedZee
    ConfusedZee Member Posts: 2
    edited April 2018

    DJMAMMO - I wanted to give you an update, had my mammo and US. The mammo was clear per the radiologist, but she saw something in the ducts and referred me to the breast surgeon so he/she can try to squeeze some out? That’s what I was told. Your thoughts on the breast surgeon referral and next steps?

    Thanks much!

  • djmammo
    djmammo Member Posts: 1,003
    edited April 2018

    ConfusedZee

    There is a test where some of that fluid is collected and sent to a lab for analysis, maybe that's what they were referring to.

    Where I have practiced if we saw something in the duct that we thought was causing the discharge we would biopsy it under US. If it came back abnormal we would send them to the breast surgeon at that time. If we could not see anything on US we would do a ductogram. If the ductogram could not be done we would go with an MRI.

  • MM350
    MM350 Member Posts: 3
    edited April 2018

    Hi I’ve been having a clear nipple discharge from one duct in one breast and have been itching and has been on going for 5 months...I went to dr, had mammogram it came back clear, no unusual microcalcification groupings so I let it go after a few months I went back to dr because I was still having discharge they did blood work which all came back normal (prolactin levels, thyroid, etc) so I asked dr what he thought was causing this and he said he thought I possibly have Intraductal Carcinoma and is sending me to a breast surgeon to do more testing...should I be worried

  • melissadallas
    melissadallas Member Posts: 929
    edited April 2018

    MM350, are you sure he didn't say intraductal papilloma

  • MM350
    MM350 Member Posts: 3
    edited April 2018

    No he said carcinoma I wish he would have said papil

  • MM350
    MM350 Member Posts: 3
    edited April 2018

    no he said carcinoma I wish he said papilloma

  • NeuroNorse85
    NeuroNorse85 Member Posts: 1
    edited April 2018

    when a duct excision is performed due to discharge is it possible to get all of the ducts removed? Like are they very visible, or is it just the connection to the nipple cut?

  • B-A-P
    B-A-P Member Posts: 409
    edited April 2018

    I'm hoping someone could shed some light. Really hoping to get some sort of reply.

    I have been having pain in one area of my breast constantly for 2 years. Tender to touch. But more recently I have been having serous nipple discharge (looks like cooking oil ) - sometimes it looks blood stained . It used to just be provoked and only came out when expressed. Now I'm finding it in my bra and shirts.

    1 year ago I had an US that showed nothing except my 13 year old fibroadenoma that is stable.

    8 weeks ago I saw a surgeon (before it became spontaneous and occasionally blood tinted ), who told me that it was normal and a majority of women could express this kind of discharge , and if I tried hard enough my other breast would have the same fluid (I've tried , it doesn't ). All she did was a clinical breast exam. I have all the red flags to have atleast some sort of follow up with tests : unilateral, watery, serous, and occasionally bloody, one pore , spontaneous and provoked , constant .

    Where I live it's so hard to see a surgeon for this kinda thing and I know if I want to see her again, I'll need re referral if my dr will send one and see if he will even follow up or give me the "it's normal speech " again.

    I am 30 so I feel like I'm being brushed off due to age and lack of major family history of B/c. And I'm not totally convinced that it's BC but I know whatever it is isn't normal and I shouldn't have to live with "it's normal to have discharge , it's normal for your boob to hurt 24/7"

    Does anyone have any insight ?


    Please and thanks

  • fiveinthenest
    fiveinthenest Member Posts: 1
    edited August 2018

    6 days ago on my 45th birthday (Friday, aug 10) I woke up after sleeping on my stomach with very sharp constant nipple and areola pain on my right breast. I pressed the nipple and a long strand of thick yellowish discharge cans out of one duct on my nipple and a tiny bead of bright red blood cane out of a duct next to it. I immediately called my doctor who got me in for an exam on Monday. She ordered diagnostic mammogram for tomorrow. I still have pain in nipple and areola but not as strong. There is a lot of pain in the area under my breast area and everything feels swollen and there are parts of my breast that feel very very tender and more lumpy than usual. I have extremely large breasts that are very dense (I have i cups) and was diagnosed with a benign fibroadenoma in nov 2015 on the other breast. I have no other skin changes in that breast with the current pain except for one pimple-like dot that is red. No itchiness, redness, just extremely painful skin and the Montgomery glands on the areola are VERY painful to the touch. No fever. I have had no discharge spontaneous or otherwise since last Friday.

    I'm of course so incredibly anxious worried about IBC or any other kind of malignancy. Could this be an infection? My whole breast is painful but not red. I started my period 4 days ago but the hormonal tenderness is usually gone by the 1st or 2nd day.

    What questions should I ask at the breast center tomorrow? Should I make sure they do US?

    Thank you! Freaking.


  • Jov016
    Jov016 Member Posts: 1
    edited January 2019

    Hi DJ,

    I've read a few articles about nipple discharge and but I'm still a little bit worried. When I got home from work and changed clothes, I noticed that my right breast nipple and areola have a different shape after removing my bra. I then examined my nipple and saw a very tiny white/yellowish discharge on top of my right nipple. After I wiped it and tried to squeeze my nipple to see if any discharge will come out, nothing came. Im not sure if this is due to hormonal change as I have read before. I will be having my period by next week so I was thinking it might be because of it. Also both of my breast are a little tender due to PMS. Im 30 yrs old and never been pregnant. No lumps on my breast.

    I will be having my check up aswell tomorrow just to see if my doctor will advise me any lab exams will be required.

    Also Im not sure if it also a factor that I am on a keto diet trying to lose weight.


    Thank you.

  • Hopingitsbenign
    Hopingitsbenign Member Posts: 5
    edited February 2019

    Hi DJMammo, I'm 54 years old with extremely dense breasts. I went for my routine mammogram and ultrasound last week and after my mammogram, the tech noticed blood on the plate. I've never had bloody discharge before!! A couple of years ago I had one incident of greenish discharge after my mammogram (I swear it was from the same duct), but never anything spontaneous or bloody. I go to a wonderful great breast imaging center (the oldest one in the country!), so they are well equipped. After seeing the blood, the tech immediately informed the radiologist who immediately ordered a ductogram. They completed that and the doctor saw some small filling defects. So they rushed me right into the biopsy room while the dye was still in my breast. The doctor performed a core needle biopsy followed by my regular ultrasound (which the radiologist did herself). My mammogram and ultrasound were normal. She told me she suspected the biopsy to show Papillomatosis or possibly hyperplasia or DCIS. She mentioned debris but didn't think it would cause multiple filling defects. Anyhow, she called yesterday... the biopsy showed no abnormal cells. It only showed fibrocystic changes and some inflammation andduct Ectasia (I've seen that on my ultrasound report before). I was so relieved... for about 3 seconds. Until the doctor told me she wants me to have an mri next week - if that is normal, she'll be happy. If it shows something in that duct, she'll want the duct removed. I asked if it's possible she missed the area during the biopsy. She seems confident that she biopsied the area of the bigger filling defect. I heard the gun go off a lot so I think she was pretty thorough. My question is... is it possible for fibrocystic changes or duct Ectasia or debris to show up as multiple filling defects? What else could cause filling defects with a normal biopsy? Could they be caused by little clots of blood? Could the mammogram compression have ruptured a capillary or cyst? I haven't bled since the mammogram. I never bled before and haven't bled since. I'm confused and worried. One interesting side note... I had mastitis in my other breast when I was 48. That was scary and bizarre. I hadn't breastfed in 4 years at that point. Maybe I'm prone to clogged ducts? That's my only unusual breast history. Thank you for your time.

  • Hopingitsbenign
    Hopingitsbenign Member Posts: 5
    edited February 2019

    Hi DJMammo, I'm 54 years old with extremely dense breasts. I went for my routine mammogram and ultrasound last week and after my mammogram, the tech noticed blood on the plate. I've never had bloody discharge before!! A couple of years ago I had one incident of greenish discharge after my mammogram (I think it was from the same duct), but never anything spontaneous or bloody. I go to a wonderful breast imaging center (the oldest one in the country!), so they are well equipped. After seeing the blood, the tech immediately informed the radiologist who immediately ordered a ductogram. They completed that and the doctor saw some small filling defects. So they rushed me right into the biopsy room while the dye was still in my breast. The doctor performed a core needle biopsy followed by my regular ultrasound (which the radiologist did herself). My mammogram and ultrasound were normal. She told me she suspected the biopsy to show Papillomatosis or possibly hyperplasia or DCIS. She mentioned debris but didn't think it would cause multiple filling defects. Anyhow, she called yesterday... the biopsy showed no abnormal cells. It only showed fibrocystic changes, inflammation and duct Ectasia (I've seen that on my ultrasound report before). I was so relieved... until the doctor told me she wants me to have an mri next week - if that is normal, she'll be happy. If it shows something I'll need another biopsy and possible duct removal. I asked if it's possible she missed the area during the biopsy. She said she biopsied the area of the bigger filling defect, but not the smaller ones. I heard the gun go off a lot so I think she was pretty thorough. She also sent smears of the bloody discharge to the lab, it was benign. My question is... is it possible for fibrocystic changes or duct Ectasia or debris to show up as multiple filling defects? What else could cause filling defects with a normal biopsy? Could they be caused by little clots of blood... maybe the mammogram compression ruptured a capillary or cyst? I haven't bled since the mammogram. I never bled before and haven't bled since. I'm confused and worried. One interesting side note... I had mastitis in my other breast when I was 48. That was scary and bizarre. I hadn't breastfed in 4 years at that point. Maybe I'm prone to clogged ducts? That's my only unusual breast history. Thank you for your time.

  • djmammo
    djmammo Member Posts: 1,003
    edited February 2019

    Jov016

    Bloody discharge is the one we worry about most, followed by clear discharge. White, green, green/blue, yellow etc we don't worry about. Also to be worrisome it should also be spontaneous, unilateral, and from only one duct opening. Squeezing the nipple to elicit discharge can cause bleeding and give you a false positive for bloody discharge. Lab work is usually done when it is milky white and bilateral to check your prolactin level.

    Bloody discharge is usually from a small growth in the duct that can be seen on US and MRI if it is big enough. For my money a ductogram (galactogram) has the best odds of identifying a nodule in the ducts if the criteria in the paragraph above are met.

  • Hopingitsbenign
    Hopingitsbenign Member Posts: 5
    edited February 2019

    Hi again DJ, I’m sorry to bother you, Im sure you get inundated with questions. I was wondering if you have any thoughts on my above post. I was trying to edit itbut inadvertently deleted it, so I had to repost it. Thank you.