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Saturday, November 22, 2014

Breast Nipple Discharge: Worry or Wait?


Nipple discharge or galactorrhea, from the breast is most often clear or white and it is due to hormone levels, previous pregnancy, previous breastfeeding, or medications that can produce it. Fibrocystic condition can produce discharges of various colors such as dark green or brownish. Bloody nipple discharge can be more serious and actually be due to something wrong with the breast itself, such as a growth within the duct, or an inflammation of a breast duct or even trauma to the breast. And often simple nutritional strategies can be tried for FCBC. Most cases of non-pregnancy associated mild discharge comes from medication. Common antidepressants, anti-anxiety medications, hormones, acid treatments like pepcid and zantac, or even pain medications and marijuana can all produce nipple discharge. Various herbals as well can cause nipple discharge including fennel, fenugreek seeds, marshmallow, red clover, red raspberry and anise. For women with bloody discharge they should not worry too much, as a British group of investigators, lead by Richards actually found that bloody nipple discharge is not often actually coming from a breast cancer. Infections can produce discharge as well.  Recently it’s been shown that diabetics are more predisposed to various conditions that can cause discharge. For most women with hormone imbalance, the discharge is out of both breasts. It may be up to your gyno to pick this up, as some discharge is only “expressible” or able to be elicited by milking the duct. Testing for what causes nipple discharge first should include an examination to see if there are masses in the breast, skin changes in the breast, or any lymph nodes that are in the region and noticeable. Might include testing the fluid obtained, hormone tests, mammograms or ultrasounds. In a 2007 Finnish study they were able to show that breast ultrasonography could discover the cause of nipple discharge in a very high percentage of cases, and even showed that cancerous cases can be found. Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland. Eighty percent of papillomatous lesions, 58% of other benign lesions, and 20% of malignant lesions were sonographically positive. They even used a method of dye injection called galactography to find out what was the cause of the discharge. This is a method of injecting dye into a single duct to follow where the fluid is coming from, particularly if the fluid was bloody. Galactography remains the primary diagnostic method, especially in depicting malignant causes of nipple discharge, which may be seen only as duct dilatation on sonography. Using a needle to biopsy, doing core biopsies, or excision biopsies, and using very small telescopes to look into the duct are other ways of finding out what is causing discharge that escapes definitive diagnosis.  It is not a good idea to not see your gyno, however watchful waiting is often the best medicine when it comes to breast discharge conditions. Most often, they simply go away.

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