Bloody Nipple Discharge, What Are the Causes?

In this clip, Dr. Jay K. Harness discusses the various causes of bloody nipple discharge and outlines the specific instances in which you should be most concerned.




Jay K. Harness, MD:  A great concern to a patient would be clearly finding a bloody nipple discharge as they would scare the heck out of anybody, particularly a patient.  Sometimes you see it happening spontaneously at the end of the nipple, probably more commonly you see a sort of a blood strain inside your bra or inside whatever you happen to be wearing.

So let us talk for a minute about the causes of bloody nipple discharge.  The first thing I want to share with you is something that you may not have thought of and that is actually most bloody nipple discharges are from a benign condition of the breast and not cancer.  That is not to say that cancer cannot cause a bloody nipple discharge but it can, but the majority of bloody nipple discharges are actually from benign conditions.

The most common benign condition is called an intra, within, ductal, within the duct, papilloma.  These are benign overgrowth of the cells that line the duct as the overgrowth becomes irritated and the surface of it is raw, blood can come out of the end of the nipple.  Or if the blood starts breaking down inside the ductal system, it will be a brownish liquidy fluid and we call that serous fluid.

Now as a breast surgeon, what do I worry about?  What I worry about are nipple discharges that are affecting only one side and are spontaneous, versus nipple discharge that are coming out from both sides or if you are squeezing the nipple aureola area, they are causing a nipple discharge.  So the medical term is, unilateral, meaning one side, spontaneous, meaning not squeezing, nipple discharge does worry us about an underlying breast cancer.

So, the work-up very importantly includes a mammogram.  If you have not had one recently, make sure out in the periphery of the breast or underneath the nipple aureola area, there is not any abnormalities we can see there and ultrasound examination, which is really important to see if the ducts are dilated or if we can see something inside the ducts.

Then, also included in the work-up very importantly, is called a ductogram, sticking a very very fine little catheter right into the duct that is discharging.  Injecting some dye in and then operating to remove that area of the ductal system.

Now, can trauma cause bloody nipple discharge, a blow to the breast or as one person asked us just recently having a mammogram, perhaps where you got squeezed too hard and there is a little bit of bleeding inside the breast, the answer is, yes.  So if there is a lump associated with what is going on or whatever it is, you absolutely need a full work-up.  Please remember that most nipple discharges are benign but they can be cancer, they can be from trauma.  Please be thoroughly evaluated and work-up completely.
