If there is a black discharge from the nipple, what can it do? Purulent cyst of the mammary gland. Pathological discharge from the chest

Having discovered discharge from the nipples, most women begin to panic, suspecting that they have a serious illness. In fact, in many cases this phenomenon is not a symptom of pathology. A woman's breast is a gland, that is, an organ capable of producing secretions. Therefore, there is no need to suffer from anxious suspicions and think about a malignant tumor. Cancer from breast discharge is rarely diagnosed. But, on the other hand, you shouldn’t completely ignore the problem either. If discharge appears, you need to contact a specialist who will examine you and, if necessary, prescribe additional diagnostics.

Lactation disorders are caused by both the inability of the mammary glands to normally perform the excretory function and pathologies of secretion. Typical lactation disorders include hypogalactia, agalactia, lactostasis and galactorrhea.

The most common condition is hypogalactia, when the mother's breasts produce less milk than the baby needs. In many cases, the situation can be improved if you follow the feeding regimen recommended by doctors. An extreme form of lactation deficiency is called agalactia. In this condition, breast milk is not produced at all, and the only option is to bottle-feed the baby.

With lactostasis, milk stagnation occurs in one or more lobes of the gland, which can result in a serious complication - mastitis.

Galactorrhea is a lactation pathology that is not associated with motherhood and the need to feed the baby. In this case, milk is released under the influence of hormonally active formations in the pituitary gland or under the influence of some other reasons. Pathological discharge from the nipples can be considered those discharges that appear three years after the last pregnancy or occur in a woman who has never been pregnant. The discharge of cloudy, serous and bloody fluid from the nipples is also considered a pathology. Such phenomena are observed much less frequently and usually indicate some kind of disease of the mammary gland.

Physiological discharge from the nipples of the mammary gland

Physiological lactorrhea can be due to the following reasons:

During pregnancy;

After childbirth;

Within 2–3 years after the last pregnancy with any outcome in women who are not breastfeeding and have a biphasic ovulatory menstrual cycle;

In newborns, within 12-14 days after birth, a sexual crisis occurs under the influence of estrogens and prolactin of the mother.

Classification of causes of nipple discharge

This classification guides doctors when making a diagnosis when pathological discharge from the nipples is detected.

Hyperprolactinemic hypogonadism (primary hyperprolactinemic hypogonadism).

Pituitary adenomas:

Micro and macroprolactinomas;

Prolactinomas in combination with adenomas in other endocrine glands;

Prolactinomas in combination with the “empty sella” syndrome.

Galactorrhea and/or hyperprolactinemic hypogonadism in combination with other hypothalamic-pituitary diseases or medical effects on the hypothalamic region.

Acromegaly.

Itsenko-Cushing's disease and Nelson's syndrome.

Hormonally inactive formations of the hypothalamic pituitary region:

Pituitary adenomas (“pseudoprolactinomas”);

Craniopharyngomas;

Chondromas, gliomas, meningiomas, angiomas in the area of ​​the sella turcica, etc.;

Dissemination of systemic diseases (sarcoidosis, xanthomatosis);

Lymphocytic hypophysitis of pregnancy;

“Empty sella” syndrome;

Chronic intracranial hypertension;

Cutting or rupture of the pituitary stalk;

Condition after proton therapy on the adenohypophyseal region.

Galactorrhea and/or hyperprolactinemic hypogonadism as a secondary syndrome in endocrine and somatic diseases, neurogenic disorders and drug effects.

For lesions of peripheral endocrine glands:

Primary hypothyroidism (VanWyck–Ross–Hennes syndrome or VanWyck–Grumbach syndrome);

Estrogen-producing tumors;

PCOS (polycystic ovary syndrome);

CAH (Congenital adrenal hyperplasia);

Addison's disease;

Diffuse toxic goiter (Tsondek syndrome).

Iatrogenic forms caused by taking medications or inserting an IUD.

Neurogenic disorders, including anorexia nervosa.

Kidney and liver failure.

Extrapituitary tumors that produce prolactin (bronchogenic carcinoma, hypernephroma).

Dyshormonal, dysplastic and tumor diseases of the mammary gland.

Mastopathy.

Ectasia of the mammary glands.

Surgeries, including plastic ones, on the mammary gland and chest.

Intraductal papilloma.

Mammary cancer.

Mixed reasons.

Idiopathic galactorrhea.

Discharge from the nipples - normal and pathological

Since the breast is a gland, discharge from it is considered normal when it is associated with feeding a baby. Scanty discharge not associated with lactation is also acceptable. Fluid may come from both nipples or from just one of them. In some cases, discharge occurs on its own, and in others - after pressing on the nipple.

The consistency of the discharge varies - it can be either thick or completely liquid. The color range is also varied - there are colorless, milky, yellow, greenish and in some cases even bloody discharge.

Abnormal discharge appears infrequently as the first obvious sign of hyperprolactinemia - in only 20% of cases. And even more rarely, they are the main complaint of patients at an appointment with a gynecologist, endocrinologist or therapist. The only exception can be considered functional (idiopathic) lactorrhea. In more than 70% of such patients, discharge is the leading sign of the disease.

In all other cases, women have other symptoms that bother them first. We are talking about disorders of the menstrual cycle and generative function, excess body weight, headaches, etc. That is, nonspecific symptoms come to the fore. Lactorrhea in such cases is often identified by a doctor after listening to the patient’s complaints and carefully examining her.

What kind of nipple discharge can be

If discharge appears from the nipples, you need to pay attention to its volume, smell and color. These signs will help draw conclusions about the suspected pathology, which may need to be treated in order to prevent the development of serious complications.

White discharge is milk and is normally observed during feeding. If milk production is not associated with lactation, we can talk about galactorrhea (when discharge from the nipples appears due to the high content of prolactin in the female body, the hormone responsible for milk production).

Yellow discharge from the breast is also considered a manifestation of galactorrhea. In this case, one may suspect a pathology of the thyroid gland, problems with the pituitary gland, or impaired renal or liver function. Yellow discharge may also occur after long courses of hormone therapy.

Brown nipple discharge

The brown tint of nipple discharge is caused by injuries to the chest, as well as damage to blood vessels and milk ducts. Such damage often occurs due to tumors, primarily breast cysts. With cysts, the discharge usually has a brownish color with a gray or green tint.

The appearance of blood in nipple discharge is an alarming sign. It may be evidence of a malignant process.

But there is no need to panic right away - it is quite possible that the discharge with blood from the nipples is caused by intraductal papilloma. (This formation, however, can eventually develop into cancer, so it cannot be ignored).

The discharge of clear fluid from the nipples is usually physiological and is observed in stressful situations, and may be associated with stimulation or the menstrual cycle. Normally, such discharge is very small, it has no odor and is not accompanied by unpleasant sensations.

Green nipple discharge

Green color indicates the presence of a certain amount of pus in the discharge. Also in this case, the discharge may have a yellowish or gray tint. Similar signs are characteristic of mastopathy, which is a dishormonal disorder with the formation of lumps and pain in the chest.

Discharge from nipples with pus

Purulent discharge from the nipples of the mammary gland is a sign of inflammatory disease of the mammary gland. Thus, purulent abscess formation results from infection entering the ducts during feeding. In this case, the breast becomes painful, the areola turns red, and severe swelling is observed.

Gray nipple discharge

A gray tint in some cases indicates an increased level of prolactin in a woman’s body. Such discharge may appear during pregnancy, as a result of a long course of hormonal medications, or after taking contraceptives for a long time.

Sticky nipple discharge

If sticky discharge appears from the chest, blockage or deformation of the subalveolar ducts may be suspected. The shade of discharge in such cases varies. Additional symptoms often appear - retraction of the nipple and thickening of the tissue around it.

Nipple discharge smells strong

If the discharge from the nipples has an odor, it means that there is an inflammatory process in the purulent stage. Pathogenic microorganisms produce waste products that have a distinct odor. When there is discharge with pus, this smell is especially strong. In such cases, discharge is not the only sign of the disease. During the inflammatory process, pain is felt in the chest, it turns red, and swelling occurs.

Black nipple discharge

The appearance of black discharge from the nipples is a clear sign of the presence of blood. This secretion is characteristic of tumor processes. In such cases, the blood turns black due to the fact that the affected area is located deep in the breast tissue, and not near its surface.

Dry nipple discharge

Dry nipple discharge is a phenomenon often observed with breast ectasia. In this case, viscous thick secretions collect in the lumen of the milk duct, from which a secretion of dense consistency is formed. Such discharge can be of different shades and differ in smell.

Curdled discharge from nipples

Discharge from the nipples with a cheesy consistency may indicate a fungal infection of the milk ducts; this can happen during breastfeeding, when there are cracks and abrasions on the skin of the nipples. Curdled discharge usually has a sour odor. A woman feels discomfort in her chest, it may itch and itch.

Nipple discharge before menstruation

If the appearance of discharge is associated with the menstrual cycle (secretion is released before or during menstruation), then there may be a serious hormonal disorder. First of all, this concerns the level of the hormone prolactin, which is responsible for lactation. Hormonal levels can change under the influence of various factors, but in most cases this is facilitated by long-term use of contraceptives.

Discharge associated with the menstrual cycle is most often scanty, transparent or with a white and yellow tint. To identify the cause of such discharge, the patient is usually referred for a blood test to assess prolactin levels.

There are cases when a woman who has given birth still has some milk before her period several years later. This phenomenon is also associated with increased prolactin levels. The fact is that in some women it decreases more slowly than in others.

Nipple discharge during pregnancy

During pregnancy, lactation and for some period after the baby is weaned, the mother may experience discharge, which is a clear secretion or colostrum. Such discharge is considered normal and indicates increased sensitivity of the nipples.

Nipple discharge when taking medications

Pathological discharge from the mammary glands may occur when taking certain medications. The list of medications is given in the table.

Pathological discharge from the nipples

Unfortunately, in some cases, discharge from the mammary glands can indicate pathological conditions and the development of serious diseases. Let's talk in more detail about the main problems accompanied by nipple discharge.

Ectasia

With this disease, the milk duct becomes inflamed, and a thick liquid, usually green in color, accumulates in its cavity. Sometimes it can be dark, almost black. Such discharge is more often observed in patients aged 40 to 50 years.

In order to alleviate the course of this disease, women are advised to apply warm compresses to their breasts. If pain is severe, the doctor may prescribe a course of anti-inflammatory drugs. Antibiotics are indicated only in case of an inflammatory process, and it is highly undesirable to take them without consulting a specialist. In case of severe ectasia, one has to resort to a radical method - surgery to remove the diseased mammary duct.

Intraductal papilloma

This pathology is a small benign formation that has formed in the cavity of the milk duct. At the moment, the reasons for the occurrence of such formations have not been fully elucidated. It is also unknown how high the likelihood of their degeneration into a malignant tumor is. A typical sign of intraductal papilloma is a bloody discharge. Moreover, in many cases they are independent (without squeezing the nipple) and their traces can be seen on the inside of the underwear. You can feel a small lump in the nipple area. Such neoplasms are usually found in women between 35 and 55 years of age.

If a papilloma is suspected, the patient is shown an ultrasound examination of the breast, as well as an X-ray of the ducts with contrast. Discharge from the nipples is sent for laboratory analysis.

Galactorrhea

In this condition, a woman's breasts produce colostrum, a brownish or yellow secretion. Most often, galactorrhea is explained by an increased level in a woman’s body of prolactin, a hormone that is responsible for the production of breast milk in the mammary glands. Sometimes other factors lead to galactorrhea: prolactinoma (a specific neoplasm of the pituitary gland), thyroid disease, hormonal imbalances associated with long-term use of contraceptives. Galactorrhea can also be caused by overstimulation of the nipples.

Chest injuries

In case of traumatic injuries to the mammary glands, completely transparent discharge or discharge mixed with blood may appear.

Mastitis

This inflammatory disease is familiar to many women firsthand. People often call it “baby”. With the development of this disease, purulent discharge is often observed (since mastitis involves the formation of an abscess in the tissues of the gland - an inflammatory focus in which pus accumulates).

Mastopathy

Fibrocystic disease is one of the most common breast pathologies. It develops with hormonal disorders and is manifested by a violation of the ratio of fibrous and cystic tissues. One of the signs of this disease is nipple discharge.

Malignant tumors

Unfortunately, in some cases, pathological discharge and nipples may indicate the development of an oncological process (breast cancer). In such cases, an intraductal tumor or invasive cancer is usually suspected. One form of breast cancer is Paget's disease, which is a malignant tumor of the nipples. This is a fairly rare pathology, accounting for no more than 4% of all cases of breast cancer. It is manifested by bloody discharge, severe itching in the nipple area and external changes (nipple configuration, areola color). If suspicious symptoms appear, you must urgently contact a medical facility to prevent the disease from reaching an advanced stage. With timely treatment, organ-preserving surgery is possible, that is, only the part of the mammary gland where the tumor is located is removed.

Diagnostic methods for nipple discharge

History taking

Pathological discharge from the nipple can be based on a variety of factors, which creates certain diagnostic difficulties. Therefore, it is impossible to find out the nature of the pathology without carefully collecting anamnesis.

First of all, it is necessary to find out all the circumstances of the patient’s life that may be associated with the appearance of discharge. Common influencing factors include: pregnancy (also interrupted), childbirth, lactation, prolonged stressful situations (especially during the girl’s puberty), traumatic injuries to the chest and chest, and traumatic brain injuries. It is also necessary to find out what medications the patient has taken or is taking. This is a very important point when collecting anamnesis, since lactorrhea can have a pharmacological origin.

Physical examination

At the very beginning, it is necessary to carefully examine the patient for signs of endocrine and somatic pathologies that could lead to the development of galactorrhea. After the examination, they proceed directly to the examination of the mammary glands.

When studying the condition of the skin, special attention should be paid to changes in turgor, humidity, and skin tone (these signs may indicate a malfunction of the thyroid gland). The presence of age spots, stretch marks and scars may indicate hypothalamic syndrome, Itsenko-Cushing's, Addison's diseases. The severity of the hairline and the characteristics of its distribution are important (in PCOS or CAH, hirsutism is observed). In addition, you need to make sure that there are no characteristic rashes, because lactorrhea may be associated with herpes zoster.

The patient's breasts are examined in two positions - sitting and lying down. Moreover, in a supine position, the patient must first stretch out her arms and then lower them. Palpation of the breast should be performed smoothly, with sliding movements from the periphery towards the areola. Then they express from the edges to the center of the areola in order to obtain discharge. If milk or colostrum-like secretion comes out during pumping movements, we can talk about lactorrhea. This phenomenon is bilateral in nature, and the degree of its severity is determined on the following scale:

- inconsistent lactorrhea (+-);
- after strong pressure, single drops are observed (+);
- after gentle pressure, abundant drops or stream appear (++);
- spontaneous discharge occurs (+++).

The volume of discharge in itself is not a valuable diagnostic criterion and can vary greatly. Much more important during the examination is a visual assessment of the discharge, which is usually performed using a magnifying glass. It allows you to distinguish lactorrhea from other pathological discharges.

A true purulent discharge is uncommon, although such discharge is sometimes noted near the edge of the areola. There may be a drainage hole for an abscess that arose after the cyst festered.

Serous-bloody or bloody discharge from one nipple, appearing drop by drop, indicates the presence of intraductal papilloma.

The discharge of a clear or greenish secretion from both nipples is a sign of fibrocystic mastopathy. Other symptoms of this common pathology are the presence of tender or painful lumps.

Quite often, when you press on the nipple, a small amount of completely transparent serous fluid appears. This phenomenon should not be alarming, since it has no special diagnostic significance and is the norm for women who have given birth.

This is followed by another mandatory stage of examining the patient - a two-manual vaginal examination. With PCOS (polycystic ovary syndrome) and primary hyperprolactinemic hypogonadism, a shrinkage of the uterus is observed. PCOS is also characterized by enlarged ovaries.

If a space-occupying process in the pituitary gland is suspected, it is necessary to examine the visual fields. In patients with macroprolactinoma, the epicenter of the lesion is located in the area of ​​the crossing fibers of the optic nerves. In some cases, this can lead to chiasmatic syndrome (bitemporal hemianopsia), which is manifested by loss of visual fields first in the superior temporal and then in the inferior temporal quadrants.

Laboratory diagnostic methods

Patients with pathological lactation are required to undergo testing of the level of the hormone prolactin. The results of such diagnostics are of great diagnostic importance. In the plasma of healthy women, the content of prolactin fluctuates within a fairly wide range (2-16 μg/l). The average value of this indicator is 8.0+-4.95 μg/l. Prolactin levels depend on the time of day. During sleep, its secretion increases, and in the morning upon awakening it sharply decreases. The minimum concentration of prolactin is observed in the late morning - between 9 and 11 o'clock.

A simultaneous increase in the secretion of cortisol and prolactin occurs after a daily intake of normal mixed food (in the middle of the day 12-13 hours). It is known that protein foods contribute to an increase in both prolactin and cortisol, and fatty foods stimulate the production of prolactin.

There are other physiological conditions in which prolactin production increases. Thus, the level of prolactin is increased in the second phase of the cycle, as well as during sexual intercourse (it increases especially strongly during orgasm). Stress and physical activity also increase the secretion of this hormone. In addition, prolactin increases during pregnancy and the postpartum period. During the examination of the patient, it is necessary to take into account all these factors so as not to distort the results and make incorrect diagnostic conclusions.

Depending on the clinical form of lactorrhea, prolactin levels fluctuate within fairly wide limits. Its maximum values ​​can exceed 100 μg/l, which is typical for tumor formations in the pituitary gland. A moderate increase - 50 mcg / l - indicates idiopathic galactorrhea, mixed lactation disorders, as well as empty sella syndrome.

There is also a normoprolactinemic variant of galactorrhea. It is diagnosed in healthy women when the lactation period is prolonged, and in patients with erased forms of endocrinopathies and some mental or somatic diseases.
To date, several molecular forms of this hormone have been described:
monomeric, or native. It is characterized by high receptor-binding and biological activity. Molecular weight - 22 kDa.

Big prolactin and big, big prolactin (big and bigbig). Molecular mass is 50 and 100 kDa, respectively. They are aggregates of native prolactin, have high immunoreactivity, and are characterized by moderate biological activity. Affinity for specific receptors is low. Conditions in which regular menstruation and normal fertility are combined with a significant increase in prolactin are today explained by “big” and “big-big” prolactinemia.

Glycosylated prolactin. Its immunoreactivity is less than that of monomeric prolactin. Molecular weight is approximately 25 kDa.

Prolactin-like peptides. Their role in the body has not yet been fully elucidated. Molecular weight – 8 and 16 kDa.

If a woman has hyperprolactinemia against the background of a normal cycle and in the absence of galactorrhea, there is reason to suspect “major” and “large-large” prolactinemia. To determine it, the gel filtration method is used.

In addition to analyzing prolactin levels, other laboratory tests are also performed. Thus, it is necessary to determine the level of TSH, since in the initial stages prolactinoma and hypothyroidism are almost indistinguishable.

Tests to determine the level of LH and FSH, progesterone, estradiol, testosterone, growth hormone, DHEAS are performed only when there is a suspicion of endocrinological pathology.

Instrumental methods

Using highly informative methods such as CT and MRI, it is possible to identify intracranial defects, small tumors (less than 5 mm) and assess the extent to which the process has spread beyond the sella turcica. These methods also make it possible to confirm a rather rare diagnosis called “empty sella syndrome.”

Modern endoscopic technologies open up opportunities for early detection of pituitary microadenoma. But to date, such methods have not yet become widespread. With their help, you can examine the pituitary fossa in detail (using a transsphenoidal approach) and identify even the smallest tumors and defects. If necessary, during endoscopy a sample can be taken for morphological examination.
If the presence of a pituitary tumor or secondary hyperprolactinemic hypogonadism cannot be confirmed, the patient is diagnosed with idiopathic lactorrhea.

Methods of treatment for pathological discharge from the nipple

Therapy for pathological discharge from the nipples depends on the cause that caused it. To find out the nature of the disease, you must consult a mammologist and undergo all prescribed examinations.

It is quite possible that hormonal levels will need to be corrected, in which case the patient may be referred to an endocrinologist. The doctor may recommend a course of drugs - DA agonists (Parlodel and Bromocriptine). These medications have the ability to slow down the production of prolactin. They are taken in a dosage of 2.5 – 3.75 mg per day. If necessary, the doctor can double the dosage. The course of treatment is continued until the hormonal levels return to normal.

It is undesirable to resort to traditional methods without the consent of a doctor. After all, it is impossible to cure a disease without knowing its causes. Self-medication can only make the situation worse. Therefore, if any suspicious symptoms appear, you should immediately contact a medical facility, undergo the necessary diagnostics and wait for a diagnosis. And only then, having received the doctor’s consent, can folk recipes based on medicinal plants be used for treatment.

The release of fluid from the mammary gland is one of the cardinal signs of the development of a disease in it, with the possible exception of pregnancy. If any discharge from the breast appears, it is necessary to be examined as soon as possible and undergo appropriate treatment.

It should be noted that this sign can be not only a pathological symptom in women, but also in men. Therefore, the appearance of strange fluid from the mammary glands should alert both women and men.

Factors leading to the appearance of discharge

The causes of discharge are numerous and varied, including many factors:

Structure of the mammary gland

The mammary gland is a paired organ whose main task is lactation, that is, the secretion of milk during breastfeeding. Most of the tissue of the mammary gland is glandular (parenchyma).

Each mammary gland has 15–20 lobes, which are separated by connective tissue septa. In turn, each lobe consists of lobes, and the last of the alveoli. From each lobe, a milk duct extends from the center towards the nipple, through which milk is secreted.

During pregnancy, glandular tissue grows, which is a necessary measure in preparation for lactation. Just below the middle of the breast is the nipple, surrounded by darker skin. The nipples and parapapillary spaces in young women and girls are pale pink, and in those who have given birth, they are dark brown. The peripapillary alveoli and nipples are covered with very vulnerable skin, which is especially important to consider during pregnancy and during breastfeeding (the risk of cracks and infection of the nipples is high).

Diseases in which discharge from the mammary gland is observed

Galactorrhea

Galactorrhea is the spontaneous leakage of milk or colostrum from the mammary gland in a non-pregnant woman or after stopping breastfeeding for a period of 5 months or more. Milk is produced under the influence of certain hormones, in particular. Galactorrhea can also be observed in men, since prolactin is also synthesized in their bodies.

The causes of galactorrhea are varied, it can be a tumor of the pituitary gland (prolactinoma), trauma or neoplasm of the hypothalamus, diseases of the thyroid gland, adrenal glands or ovaries, renal and liver failure, stress and much more. If the reason for the spontaneous flow of milk is not established, they speak of idiopathic galactorrhea.

The main symptom of the syndrome is white discharge from the chest. Women also experience hirsutism (excessive hair growth), acne, and decreased libido. Treatment of galactorrhea consists of treating the underlying disease. For idiopathic galactorrhea, bromocriptine is prescribed, which reduces the synthesis of prolactin.

Ectasia of the milk ducts

Progressive dilation of the milk ducts with subsequent inflammation leads to a disease such as milk duct ectasia. Thick and sticky discharge from the breast appears, most often brown in color.

This disease occurs in premenopausal women. Treatment involves prescribing warm compresses to the chest and taking non-steroidal anti-inflammatory drugs (indomethacin), in some cases antibiotic therapy is required. In difficult situations, surgical removal of the milk duct is performed.

Mastitis

An acute infectious disease of the breast, or, as a rule, occurs during breastfeeding. The disease is acute, the breast swells, becomes sharply painful, and the skin of the mammary gland becomes hyperemic. There is a significant increase in temperature, up to 39 degrees, green discharge from the mammary gland occurs due to an admixture of pus.

The causes of mastitis can be improper breast expression and the development of lactostasis, cracked nipples and failure to comply with hygiene rules. As the process progresses, mastitis turns into an abscess form, and the woman’s condition worsens. Treatment is aimed at avoiding feeding from the affected breast, prescribing antibiotics and detoxification therapy. When a breast abscess develops, the abscess is surgically opened.

Chest injury

With severe trauma to the chest, pain and bloody discharge appear in it, and as it heals, it becomes yellowish or transparent.

Fibrocystic mastopathy

Signs other than discharge include pain that appears in the second phase of the menstrual cycle. Yellow discharge is also associated with the phase of the menstrual cycle and disappears with the onset of menstruation. Treatment of the disease consists of prescribing diet, hormonal and vitamin preparations.

Case Study: A neighbor came to me with complaints of pain in the mammary gland and a mass discovered in it. Indeed, upon palpation, a dense, palm-sized formation with clear boundaries was palpable. In addition, when pressing on the nipple, a yellowish discharge appeared. As it turned out, the woman was in the second phase of the menstrual cycle, which suggested mastopathy. The diagnosis was finally confirmed after menstruation, when the breasts became soft and the discharge from the nipple disappeared.

Mammary cancer

A malignant breast tumor has very characteristic symptoms. Externally there is redness, it takes on the appearance of a lemon peel, and may be hot to the touch. On palpation in the chest, a dense formation with uneven boundaries and enlargement of the axillary lymph nodes are noted. The shape of the nipple also changes, it retracts, and dark discharge appears. Treatment for breast cancer is only surgical.

Case Study: A woman came to see me complaining of pain in her right mammary gland. Palpation yielded nothing. I did not identify the tumor; the appearance of the breast was unchanged. When collecting an anamnesis, she revealed a chest injury about 2 weeks ago. Just in case, I sent the patient to the oncology clinic to see a mammologist. Imagine my surprise when she was diagnosed with cancer. Pain in the mammary gland during cancer occurs at the very last stage, when all other signs are present.

Discharge from the mammary glands during pregnancy

Pregnancy and breast discharge are not such a rare occurrence. As a rule, they are yellowish or milky in color and are nothing more than colostrum - a harbinger of milk. During gestation, the mammary glands actively increase in volume due to the proliferation of glandular tissue under the influence of intensive production of prolactin.

Colostrum usually appears on the eve of childbirth, but it can begin to be produced earlier, at 22–24 weeks. After childbirth, colostrum is replaced by milk synthesis within 2–3 days. Compared to milk, colostrum is a higher-calorie food and contains more antibodies, which are very necessary for the child in the first days of life. It is very important to observe the rules of personal hygiene and monitor the condition of the nipples during the appearance of discharge from the breast during pregnancy.

It is necessary to wash your breasts with boiled water at least twice a day and wipe dry. Air baths are also useful for nipples, which helps prevent cracks in the postpartum period. It is recommended to use sterile cotton pads as breast pads, which are freely available in pharmacies.

Breast discharge is normal

There are 2 situations when clear discharge is normal.

• Firstly, this is one to two days before the start of menstruation,
• Secondly, sexual arousal, nipple stimulation and orgasm.

Under the influence of oxytocin, which is produced during nipple stimulation, the milk ducts contract and fluid appears (one to two drops).

On the list of the most common breast conditions for which women seek medical attention, unusual nipple discharge ranks third. Data from a corresponding study were published by the Journal of Cellular Immunotherapy, placing nipple discharge in third position after breast pain and tumors.

I wonder what Nipple discharge can appear not only in women, but also in men. However, this problem does not always indicate serious illness.

In men, nipple discharge is much more unusual, so if a man experiences this symptom, it is recommended that he consult a doctor immediately.

Fast Facts About Nipple Discharge

1. This symptom appears when the nipples produce fluid.
2. The fluid released from the nipples can be of different colors and different consistencies.
3. Sometimes a person leaks fluid from only one nipple.
4. Many body conditions can lead to nipple discharge.

Why does nipple discharge appear?

There are many different reasons for nipple discharge in women. One of the most common is that nipples begin to leak when a mother stops breastfeeding her baby.

Sometimes a woman may experience nipple discharge for two or even three years after stopping breastfeeding.

A list of other causes of nipple discharge includes:

• abscesses (acute chest infections);
• breast infections;
• endocrine (hormonal) disorders;
• overstimulation of the nipples;
• fibrocystic mastopathy;
• history of chest injury or trauma;
• milk duct ectasia (milk ducts enlarge and become excessively wide);
• Paget's disease of the breast (a rare type of cancer that affects the nipple and areola);
• side effect of birth control pills;
• periductal mastitis (inflammation);
• prolactinoma (a hormonal disorder caused by a tumor in the pituitary gland).

Some pharmaceutical products and herbal medicines may also cause nipple discharge. The group of such funds includes:

• drugs to treat high blood pressure;
• neuroleptics;
• antidepressants;
• sedatives;
• fennel;
• fenugreek.

Taking marijuana or cocaine can also cause nipple discharge.

Causes of nipple discharge in men

Sometimes men also experience nipple discharge, which can be caused by the following reasons:

• testosterone deficiency;
• gynecomastia (a condition that causes breast enlargement and tenderness);
• tumor of the pituitary gland (the pituitary gland is responsible for producing hormones that cause the secretion of milk in the nipples);
• breast cancer

Since nipple discharge is much less common in men than in women, if this condition is detected, a man should immediately see a doctor.

Sometimes nipple discharge occurs in young children. This occurs immediately after birth, when maternal hormones are still present in the baby's body. As a rule, this side effect disappears a few days after birth.

What types of nipple discharge are there?

To find the cause of the problem, doctors often ask patients questions about the discharge they are experiencing. In particular, they are interested in the color of the secreted liquid and its consistency.

A list of the most common types of nipple discharge includes:

• Milky discharge. This is the most common type of discharge. In women, it may appear due to the cessation of breastfeeding or as a result of hormonal changes during the period.
• Bloody issues. Bloody discharge may be caused by a noncancerous tumor called a papilloma. This formation can irritate the tissue inside the thoracic ducts. In rare cases, spotting in the breast is a consequence of the development of cancer.
• Transparent discharge. Clear discharge from only one breast may indicate cancer. Clear discharge from both nipples should be less of a concern, but if a woman is concerned, she should see a doctor.
• Isolation of green shades. Discharge of this color may indicate that there is a cyst under the nipple or areola that is leaking.

While each of these types of discharge can cause anxiety, you should not worry prematurely. In cases of cancer development, bloody and clear discharge is most common.

How to treat nipple discharge?

Ways to get rid of nipple discharge depend on the cause and type of discharge.

Doctors will examine the body, make a diagnosis, and then begin treatment, which usually solves the problem.

When should you visit a doctor?

It is necessary to see a doctor every time a woman experiences nipple discharge that causes her concern. Seek medical help immediately if you have additional symptoms associated with breast cancer. These symptoms include:

• palpable swelling in the chest;
• changes in breast size or shape;
• discharge from only one breast;
• bloody issues;
• discharge that lasts for several days;
• breast swelling;
• swelling under the arms and in the collarbone area.

The doctor will ask the woman about her symptoms and perform a breast examination. He may also recommend other diagnostic procedures, such as a mammogram or ultrasound, to detect abnormalities in the breasts, if any.

After these diagnostic procedures, your doctor may recommend other tests, such as a blood test or biopsy.

Is nipple discharge linked to cancer?

According to the International Journal of Preventive Medicine, nipple discharge may indicate breast cancer.

The same publication reported that among those women who seek medical help because of nipple discharge and do not know about their diagnosis, from 7 to 15% subsequently learn about breast cancer.

That is, in the vast majority of cases, nipple discharge does not indicate cancer. However, the most common types of cancer in women experiencing nipple discharge are ductal carcinoma in situ and papillary carcinoma.

If the doctor is unable to reliably determine the underlying cause of nipple discharge, he usually recommends that the patient undergo additional diagnostic procedures to ensure that there are no dangerous cells in the breast tissue. Women who are at increased risk of developing cancer should seek medical help as soon as possible if they experience this symptom.

Doctors usually associate a high risk of breast cancer with those women who either have relatives who have suffered from a similar disease, or who themselves have been treated for breast cancer or other types of malignant tumors.

The mammary glands are one of the most vulnerable organs in a woman. The greatest burden falls on them during the period of feeding a newborn baby. Therefore, discharge from the breast is a common thing for the fairer sex. Phenomena that are not directly related to milk synthesis should be alarming. However, any liquid passes through the same tubules. Sometimes only drops emerge from them, and sometimes there is quite a lot of discharge. It is also necessary to pay attention to which of the mammary glands releases fluid when pressed. It can come from both. In such a case, the state of affairs indicates the development of serious diseases.

Natural causes

A small amount of discharge from one or both breasts is completely normal. If its volume increases sharply and the woman’s breasts have an uncharacteristic appearance, this is a signal that a serious illness may develop.

When pressed, the liquid can drain for completely natural reasons. Such situations are explained by the fact that any gland produces a certain substance.

A woman's breasts also produce some secretions, which may sometimes be released. It is imperative to pay close attention to the color and nature of the leaking liquid. Under normal conditions it should be completely transparent.

The secretion can come out spontaneously or when pressure is applied. This usually happens when:

• there is pregnancy;
• immediately after the end of the breastfeeding period;
• there is a hormonal imbalance;
• uncontrolled use of contraceptives;
• taking psychotropic medications;
• the bra does not match the breast size;
• there is a predilection for tight clothes;
• severe arterial hypertension is observed;
• a violation occurred;
• the woman smokes a lot;
• she abuses alcohol;
• intoxication occurred;
• metabolism is impaired;
• chronic fatigue is observed;
• there is a passion for various diets;
• suffered an abortion;
• heavy physical work is performed, etc.

The presence of discharge indicates preparation for lactation, restructuring of the activity of the mammary gland after the end of breastfeeding, or disturbances in the functioning of the organ.

During various phases of a woman’s menstrual cycle, a small amount of clear secretion may be observed. This is an absolutely normal phenomenon and it would still be useful to consult a doctor in this case.

After a miscarriage, as well as a medical or surgical abortion, the preparation of the mammary gland for the birth of a child does not yet have time to completely undergo reverse changes. Therefore, a little secret may well be released from it. The longer the pregnancy is, the higher the volume of fluid leaked will subsequently be.

With prolonged use of hormonal contraceptives, the synthesis of prolactin, which stimulates the production of breast milk, can be activated. In cases where there is too much discharge, the contraceptive should be immediately discontinued.

Signs of pathology development

If the patient experiences any fluid that appears when pressing on the mammary gland, an urgent need to consult a specialist. He will diagnose and prescribe treatment.

Discharge of an uncharacteristic color may indicate obvious trouble. This is a greenish liquid that flows from a woman's breast when pressure is applied to it. Most often it accompanies a disease such as mastitis. Usually there is pain and peeling of the skin at the same time.

Yellowish discharge may appear after severe organ trauma. If a similar phenomenon is observed after the end of the patient’s menstrual cycle, then we are most likely talking about the development of fibrocystic mastopathy.

The brown color of discharge from the mammary gland when pressed is noted in cases of tissue damage followed by severe bleeding. It can also be caused by the formation of a neoplasm.

Secretion with a red admixture is a symptom of an oncological process, which, as it progresses, destroys the cells and vessels of the mammary gland.

Whitish breast discharge that occurs when pressure is applied is called galactorrhea, and the protruding fluid is called colostrum. It is most often observed with irregularities in a woman’s menstrual cycle.

The dark color of the secretion is a clear indicator of the development of a dangerous pathology. It is present in many diseases. Its color indicates the presence of constant bleeding and can signal the development of cancer.

Breast discharge that has a dark green tint is also possible. They are usually observed with mastopathy and other inflammatory reactions in the mammary gland. Most often, this color indicates the addition of a purulent infection.

You need to be alert immediately if, in addition to leaking fluid, certain symptoms are also noticed, which include:

• severe pain in the mammary gland;
• unpleasant sensations when pressing on the nipple, localized on both sides;
• constant discomfort in the woman’s chest area;
• rubbing sensation;
• nipple cracks;
• significant swelling;
• a sharp change in the shape of the female breast;
• severe redness;
• cyanosis of the mammary gland;
• pain in the armpit.

These dangerous symptoms are characteristic of an inflammatory process, mastitis, infection, congestion, cyst formation or the appearance of a tumor.

It is also very important to establish the frequency of occurrence of such unpleasant sensations, the intensity of pain and pay attention to any changes in the shape of the nipple. In addition, it is worth taking a closer look at whether one mammary gland is affected or whether similar phenomena are observed in both. It is necessary to assess the amount of discharge after pressing on a woman’s breast and find out whether any fluid is oozing from it spontaneously.

It will be useful to check which pharmacological agents the patient is currently taking and how long she has been using contraceptives.

You also need to measure her body temperature, pay attention to the accompanying symptoms and remember how long ago they appeared.

If you have recently experienced a breast bruise or other injury, you should immediately consult a doctor.

Causes of diseases

The appearance of discharge when pressed can occur in a variety of pathologies. Therefore, you should not wait until the process stops by itself, but it is better to immediately pay a visit to a specialist. Only he can identify the real cause of breast dysfunction and prescribe appropriate treatment. Nowadays, there are many different techniques that allow you to quickly and successfully cope with even the most severe diseases.

Most often, such trouble is observed in cases where there is:

• galactorrhea;
• intraductal papilloma;
• ductectasia;
• mastopathy;
• mastitis;
• injury;
• vaginitis;
• neoplasm (benign or malignant);
• Paget's disease;
• side effects of taking certain medications;
• long-term treatment with antibiotics;
• endocrine pathology;
• dermatitis;
• syphilis, etc.

These diseases can cause hormonal imbalance, disrupt the functioning of breast tissue or provoke changes in its secretory functions. They are the most common and usually involve discharge from a woman’s breast when pressure is applied. Of course, such reasons are not the only ones, but the doctor will first of all suspect the development of such diseases.

Duct ectasia is very often diagnosed. It consists of changes in the structure and shape of the intrathoracic tubules, resulting in thickening of the mammary gland. More often, pathology occurs after forty years.

Papilloma is a benign connective tissue tumor characterized by pain and colorless discharge, as well as reddish or green liquid that forms when pressure is applied to a woman’s chest. As a rule, patients who are in menopause complain about its development.

Injury to the mammary gland causes severe swelling, discoloration and pain. It is often accompanied by pink or yellow discharge.

When the activity of the pituitary gland is disrupted, a sharp hormonal imbalance occurs. Therefore, it is quite possible that it will provoke the leakage of secretions from a woman’s breast as a result of changes in the synthesis of prolactin.

The general condition of the thyroid gland is also important. It largely regulates the overall hormonal levels of the body. With her diseases, the pituitary gland is also able to react, increasing the secretion of the same prolactin. In this case, active production of breast milk will begin, similar to what occurs in preparation for pregnancy.

When cancer appears, symptoms may be absent for quite a long time. The doctor's attention is usually drawn to nodules in the breast tissue, uncharacteristic discharge or minor pain.

Contacting a specialist is necessary, since these diseases should under no circumstances be neglected.

Diagnostics

Pathological processes in the mammary gland are the sphere of influence of the mammologist. When contacting him, you will be assigned:

• mammography;
• microscopy and culture of breast discharge;
• ultrasonography;
• Magnetic resonance imaging;
• clinical blood test;
• cytological examination;
• tests for the level of various hormones in the body;
• radiography;
• ductography;
• biopsy, etc.

These diagnostic methods allow you to examine the structure of the mammary gland, assess the degree of its functionality, identify the presence of an inflammatory or infectious process, and also eliminate the risk of developing a cancerous tumor.

In addition, the doctor will listen to the patient, analyze her complaints, trace her medical history, and find out about cases of malignant neoplasms in the woman’s family.

He will then conduct a thorough contact examination of the breast. The concentration and appearance of the discharged fluid will be assessed, as well as the presence of blood in it. The specialist will carefully examine the condition of the breast itself. First of all, he will check for compliance with the norm the size, shape, color, type of nipple, its color and the severity of any changes.

If there are nodules, lumps or painful tumors in the patient’s mammary gland, he will conduct a differential diagnosis.

Treatment

After clarifying the reasons for the appearance of discharge when pressing on a woman’s chest, the doctor will prescribe appropriate treatment. He will recommend therapy with pharmacological drugs, a puncture to treat an inflammatory disease or infectious process, and possibly surgery to excise the affected areas. The choice of correction method depends entirely on the diagnosis, the advanced stage of the disease and the threat to the patient’s life.

With timely treatment and the pathology not being too severe, therapeutic treatment is possible.

It includes the following:

• Antibacterial drugs;
• antiviral agents;
• anti-inflammatory substances;
• hormones;
• immunostimulants;
• wound healing drugs;
• antihistamines;
• probiotics, etc.

These drugs will get rid of the cause of the disease, help avoid complications, stabilize a woman’s hormonal levels and normalize the processes occurring in the mammary gland. If you consult a doctor in time, treatment is quick and ends with complete recovery.

There should be no independence in this case. The cause of the disease must be identified by a specialist, and only he can determine the most effective methods of getting rid of it.

The use of warm compresses, heating pads, or the use of medications not prescribed by a doctor is completely excluded. Such measures can transform the course of the disease into chronic and cause severe complications.

If conservative treatment methods are ineffective, the disease is severe, or an oncological process is present, surgery is necessary. Typically, specialists try to use gentle, low-traumatic methods that lead to a quick recovery.

If an inflammatory process develops or an infection that causes an abscess is attached, it is necessary to open this formation, carry out drainage and carry out thorough treatment with antibiotics.

If intraductal papilloma is diagnosed, it is resected. Then the excised material is sent for cytological examination to exclude the possibility of degeneration into a malignant tumor.

Sometimes complete removal of the mammary gland and regional lymph nodes and subsequent long-term and difficult treatment of the patient are required. Therefore, a timely diagnosis allows you to avoid a long and difficult path.

To maintain the health of a woman's breasts, it is necessary to follow preventive measures.

To do this you need:

• Wear a bra of the appropriate size;
• no smoking;
• balance nutrition;
• try to eliminate traumatic situations from your life;
• avoid excess weight;
• take contraceptives only after consultation with a gynecologist;
• do physical education;
• visit a mammologist regularly.

At the slightest discomfort in the breast or nipple area, a woman should urgently visit a doctor. This is especially necessary to do if, when pressing on the chest, the presence of any discharge is noted. An alarming symptom is their reddish, greenish or brown color.

You should visit a specialist even if the woman’s health is fine and the condition of her mammary glands does not bother her. With early detection of diseases, the treatment prognosis is always favorable.

One of the common symptoms of a variety of diseases: discharge from the breast. Discharge from the mammary glands when pressed - causes and prevention of this symptom. What does nipple discharge mean? How do you know if you should worry or if an unpleasant symptom will go away on its own? Why do they appear?

Let's figure out why fluid appears from the mammary glands and how dangerous it is. Every woman has noticed at least once in her life that discharge appears from the nipple. They can be of very different colors: from transparent to yellow, and do not always indicate a disease. If discharge appears after pregnancy, everything is clear: breast milk has started. But what to do if your chest hurts and fluid leaks for no apparent reason? There is no need to worry, you need to assess the nature of the discharge and accompanying symptoms, and of course, consult a specialist for advice.

The mammary glands are a secretory organ. They are designed to release secretions into the external environment. Breast milk usually begins to flow during pregnancy, and production increases during breastfeeding. Discharge can be bothersome even in the absence of pregnancy. If fluid is released from the breast in quite large quantities for no apparent reason, most likely the problem is associated with a sharp change in hormonal levels. This situation requires mandatory consultation with a doctor, but in the absence of other symptoms, it does not pose a health hazard.

Discharge may appear from only one nipple, or from both. In the first case, they indicate possible problems with the mammary duct and may be a symptom of mastopathy. In the second case, they mean systemic dysfunction.

Clear fluid from the nipples, which is released in small quantities during certain phases of the cycle, is considered normal. You should be concerned if the discharge has an uncharacteristic color (yellow, green) or smell. If they are accompanied by pain, you need to consult a doctor, there is a high risk of developing an infectious process.

What do they indicate?

Nipple discharge in itself is not a specific disease, but can signal problems in the female body. Some of these diseases progress rapidly without appropriate treatment. Therefore, it is important not to self-diagnose and use the help of specialists.

May indicate the following diseases:

• mastitis
• milk duct ectasia
• mastopathy of the mammary glands
• papilloma
• infectious diseases
• consequences of injuries
• malignant neoplasms (as one of many symptoms)

Symptoms

If purulent discharge is observed, mastitis may develop. This is a fairly common diagnosis. The disease is characterized by the accumulation of purulent contents in the mammary glands. With mastitis, white or yellowish discharge is observed, with a green tint, often with an unpleasant odor. Severe and persistent chest pain appears. Symptoms may occur in one breast or both.

If the discharge is abundant, frequent and little related to the phases of the cycle, it may indicate ectasia of the milk ducts. Liquid of viscous consistency, with greenish tints. The development of the disease is rapid, symptoms progress rapidly. This disease most often appears after 40 years of age.

Light and white discharge that looks like clear milk may be a sign of hormonal dysfunction associated with decreased prolactin production. In this case, the main treatment will be to restore normal metabolism. The disease occurs as a result of diseases of the endocrine system, in the presence of tumors, and when taking incorrectly selected oral contraceptives.

Another cause of discharge may be intraductal papilloma. This is a benign formation that occurs in the lumen of the mammary gland duct and most often occurs after 35 years. The main symptom: liquid that will flow only after pressing. If you do not put pressure on the mammary gland, the fluid will not be released. This disease has been little studied, so treatment is prescribed individually, after additional examinations.

Dark or yellow discharge is characteristic of mastopathy. The disease develops due to hormonal imbalances. The chest hurts in the second phase of the cycle. Over time, symptoms progress. Mastopathy is quite easy to treat if you consult a doctor as soon as your breasts begin to hurt, when the first signs of the disease appear.

In some cases, with mechanical injuries, colostrum is released. In the absence of accompanying symptoms, this is not dangerous. If symptoms do not go away within a month, you should consult a specialist.

Pain and discharge are rare with cancer. Fluid may come out of the nipples when pressed. Pressure and palpation also reveal some tenderness. However, oncology is not determined by such symptoms; it has much more eloquent manifestations. Therefore, when fluid appears from the nipples, you should not think about oncology.

Diagnostics

To diagnose a specific disease, a set of methods is used. First of all, the doctor performs a visual examination and palpation. During the study, it is possible to identify compactions and swelling of tissues, delimit the affected areas and find out their nature.

It is clear that visual assessment in most cases is not enough to make a correct diagnosis. As clarifying studies, the following are prescribed: ultrasound, mammography, cytological tests and general blood test. If hormonal diseases are suspected, a separate test for sex hormones and thyroid hormones is prescribed.

Often, you may need to consult a specialist, for example, a gynecologist-endocrinologist. Initially, patients should contact a mammologist or therapist, who, if necessary, can refer them to a doctor with a different specialization.

Prevention

To protect yourself from unpleasant symptoms, it is recommended to remember preventive measures. Women who are breastfeeding or who have given up breastfeeding should especially carefully monitor the condition of the mammary glands. So, breast milk must be expressed on time. If breast milk begins to stagnate, an inflammatory process may develop.

• Conduct self-examinations by mastering simple technology. If lumps are detected, consult a doctor promptly.
• Avoid injury to the mammary glands.
• Use oral contraceptives only after your doctor's approval.

Only a doctor can say exactly why the discharge appeared and how to get rid of it. A certain amount of fluid may be released in a completely healthy woman or it will be evidence of a pathological process.

Treatment

It is worth noting that treatment depends on the disease. All treatment regimens are divided into two large groups: conservative therapy and surgical treatment. The second option is rarely used when tumors are detected. In other cases, treatment will depend on the disease that caused the unpleasant symptoms.

If tests show an infectious process, antibacterial drugs are prescribed. For hormonal imbalances, treatment includes hormone replacement therapy. The main indicator of successful treatment: a pronounced effect during the first two weeks of treatment.

If conservative therapy is ineffective, surgical treatment is prescribed.

It is important to remember that self-medication is dangerous and can lead to complications. One symptom alone cannot make an accurate diagnosis. If discharge appears, you should contact a specialist and follow his recommendations.