Chapter 5 – The Breast

Nipple changes, discharge and Paget’s disease

Benign nipple changes include:

slit-like retraction inversion that can be easily everted

Clinically abnormal or suspicious nipple changes include:

colour and skin texture change fixed whole nipple inversion ulceration(2)

Benign nipple discharge is common and typically seen from multiple ducts, and is milky or greenish in colour. When investigating nipple discharge you should note its appearance and determine if the discharge occurs only with expression or spontaneously, and whether it is bilateral or unilateral and from a single or multiple ducts. Unilateral, spontaneous, bloody or serous discharge from a single duct raises the possibility of cancer, especially if it occurs in women over 60 years.

Cytology of the discharge can be performed:

A positive discharge cytology result is indicative of cancer (highly specific). A negative discharge result cannot be used to rule out cancer (low sensitivity).

Imaging should include mammography and ultrasound.

Mammary duct ectasia (a benign condition) is associated with dilatation and inflammation of the ducts under the nipple and usually causes a bilateral yellow, green, or brown discharge from multiple ducts.(12)

Hyperprolactinaemia (high prolactin levels) may cause galactorrhoea. Aetiology includes endocrine causes, e.g. pituitary and thyroid disease; and drug causes, e.g. oral contraceptives, hormone therapy, antiemetics, antipsychotics, cocaine, and stimulants.(12)

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Paget’s disease of the nipple

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