Nipple Discharge and Bleeding

Fluid coming from the nipple when you are not breastfeeding is common, and most of it is harmless. Doctors pay attention to discharge that comes by itself without squeezing, from one breast only, from a single duct opening, and that is clear or bloodstained. That pattern points to something growing inside one milk duct.

The usual cause of bloody discharge is an intraductal papilloma, a small benign wart-like growth. In roughly one in ten cases, more often after the age of 50, the cause is an early breast cancer, so every case of bleeding from the nipple deserves a proper assessment. Bleeding from the nipple skin itself, with crusting or a sore, is a different problem.

Symptoms

• Bloodstained, brown or clear watery fluid on your bra or nightclothes
• Discharge from one pinpoint opening on one nipple
• Green, yellow or milky discharge from several ducts on both sides, which is usually benign
• A small lump just behind the areola
• A red, scaly, itchy or ulcerated nipple that does not heal
• A nipple that has recently pulled inwards

Causes and risk factors

Intraductal papilloma is the leading cause of bloody single-duct discharge. Duct ectasia, a widening and inflammation of ducts around the menopause, gives thick green or brown discharge. Ductal carcinoma in situ and invasive cancer are less common but important. Milky discharge from both breasts comes from raised prolactin, due to pregnancy, certain medicines such as antipsychotics and anti-sickness drugs, an underactive thyroid or a benign pituitary growth. Cracked skin from breastfeeding, friction in runners, eczema and Paget's disease of the nipple cause bleeding from the surface. Bloodstained milk in late pregnancy is usually innocent and brief.

How it is diagnosed

• Examination: Identifies whether fluid comes from one duct or many, its colour, and any lump or skin change.
• Mammogram and targeted ultrasound: Ultrasound behind the nipple can often show a papilloma or a widened duct.
• Breast MRI: Helpful when mammogram and ultrasound are normal but suspicious discharge continues.
• Biopsy: Core biopsy of any lesion seen on imaging, or a small punch biopsy of abnormal nipple skin.
• Prolactin and thyroid blood tests: For milky discharge from both sides.
• Ductography or ductoscopy: Available in some centres to outline or look inside the discharging duct.

Treatment options

• Observation: Normal imaging with non-bloody discharge from several ducts usually needs reassurance only. Avoid squeezing, which keeps it going.
• Microdochectomy: Removal of the single affected duct through a small cut at the edge of the areola. It both treats and diagnoses persistent bloody discharge.
• Total duct excision: Removal of all the major ducts behind the nipple for troublesome discharge in women who have finished breastfeeding.
• Treating the cause of raised prolactin: Changing a medicine, thyroid replacement, or cabergoline for a prolactinoma.
• Cancer treatment: If biopsy shows DCIS or cancer, treatment follows breast cancer pathways.
• Skin care: Nipple shields or lubricant for friction, and topical treatment for eczema once Paget's disease is excluded.

When it is urgent

This is seldom an emergency, but do not leave it. Arrange a breast clinic appointment locally within 2 weeks for bloodstained or spontaneous one-sided discharge, a new lump, or a nipple sore. Go to urgent care for a hot, swollen, painful breast with fever.

Travelling to Türkiye for treatment

The first assessment should happen near home and soon. Travel may be reasonable afterwards for a second opinion on imaging and pathology, or for a planned duct excision, which is a day-case operation needing about 5 to 7 days in Istanbul and a wait of several days for the pathology report. If the result were to show cancer, the longer course of treatment is generally better organised close to where you live.

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Frequently Asked Questions