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Nipple Conditions

nipple problems and discharge nipple discharge Types of Nipple Discharge Ectasia risk factors for nipple

Overview

Nipple conditions commonly manifest as discharge, pain or itching. It can affect people of both genders and should be checked immediately. In most cases, nipple conditions do not indicate cancer. However, you should seek medical consultation at the earliest to rule it out and get the necessary treatment.   

Types of Nipple Conditions

There are several types of nipple conditions. Some of the most common types are: 

  1. Ectasia
    Ectasia is often considered a part of the normal ageing process. It is a benign (non-cancerous) breast condition. It occurs when a milk duct in the breast widens and its walls thicken causing blockage and fluid build-up. It is commonly seen in women nearing menopause.  
  2. Intraductal Papilloma
    Intraductal papilloma are benign tumours which grow within the milk ducts. They have a wart-like appearance. They can be painful in certain cases and are felt as a small lump behind or beside the nipple. Multiple papillomata can increase the risk of developing breast cancer slightly.  
  3. Nipple Discharge
    Nipple discharge is defined as the abnormal and spontaneous flow of liquid from the nipple for reasons other than lactation. Galactorrhoea is a condition when there is a milky discharge from both nipples (not when the woman is breastfeeding). Nipple discharge can appear milky, clear, yellow, green or bloody. Nipple discharge usually indicates an underlying benign condition. However, breast cancer is a possibility if it is accompanied by a lump in the breast, if only one nipple is affected, if the discharge is bloody or clear and if the discharge is persistent. 
  4. Paget’s Disease of the Nipple
    Also called Paget’s disease of the breast, is a rare form of breast cancer. While the exact cause isn’t known, it is widely theorised that it is caused by the migration of tumour cells through the milk ducts to reach the nipple and areola. However, in some cases, Paget’s disease of the nipple doesn’t necessarily mean the presence of breast tumours. It is characterised by redness, flaking, crusting or scaling in the nipple reason accompanied by a tingling or itching sensation. It is often confused with eczema, dermatitis or other common skin conditions. Additional symptoms include thickening skin near your nipple, flattening of the nipple, yellowish or bloody discharge and increasing breast sensitivity. 

About The Condition

Problems with the nipples and areolas usually indicate an underlying condition. They become more common with age. Seeking timely medical intervention is key in diagnosing the root cause and getting effective treatment. Contrary to common belief, nipple condition can affect both men and women and it does not always mean breast cancer. In many cases, irritation, soreness and even cracking is caused as a result of friction or infections, but it is best to seek medical attention to rule out any other severe condition.

Risk factors of Nipple Conditions

It is difficult to pinpoint accurate risk factors for nipple conditions as they are usually symptoms of an underlying condition. However, a few of the factors that can increase the chances of benign conditions developing are: 

  1. Pseudocyesis or false pregnancy (it can lead to nipple discharge) 
  2. Medications 
  3. Overexertion  
  4. Trauma 
  5. Endocrine disorders 
  6. Age

Symptoms

Some common signs indicating nipple conditions are: 

  1. Itching or irritation in the nipple region/areola  
  2. Lump/lumps on or beside the nipple  
  3. Tenderness or soreness in the nipple 
  4. Abnormal discharge from one or both the nipples 
  5. Cracked or bleeding nipples 
  6. Change in nipple shape

Diagnosis of Nipple Conditions

Nipple conditions are diagnosed in several ways. In the initial stage, details of the patient are taken. This includes details of their symptoms, if they are on any type of medication and if they are or recently were pregnant.  

A physical examination would follow the initial physical exam.  

Based on the above tests, the doctor can then recommend any of the following diagnostic procedures: 

  1. Ductography
    A dye would be injected to identify any blockages. 
  2. Mammogram/breast ultrasound
    You could be asked to undergo advanced imaging tests to scan for any lumps. 
  3. Skin biopsy
    Tissue samples would be examined to test for any cancer/abnormal cells. 
  4. Prolactin test
    Prolactin is a hormone produced by the pituitary gland which causes lactation, it is present in small quantities in both men and women. This test is conducted to monitor the levels of prolactin present in the blood to check for any abnormalities. 
  5. Thyroid hormone test
    This test is to check if there are any abnormalities in the thyroid gland causing the nipple condition.  
  6. CT scan/MRI
    These advanced imaging tests are conducted to either confirm diagnosis or to get a clearer picture in the case of inconclusive results.

Treatment of Nipple Discharge

Depending on the cause, the doctor can recommend a number of treatments for nipple conditions such as: 

  1. Ectasia
    The most basic treatment recommended for ectasia is applying warm compress on the affected area. In case of an underlying infection, a course of antibiotics would be prescribed to the patient.  
  2. Intraductal papilloma
    Your doctor would surgically remove intraductal papillomata using a procedure called excision biopsy. This can be carried out under a local or general anaesthetic. The excised tissue would then be examined to confirm diagnosis. 
  3. Galactorrhoea
    Treatment would depend on the underlying cause of the galactorrhoea. In case of medication, the doctor might prescribe alternatives. The doctor might also recommend medication to reduce prolactin production.   
  4. Lactational mastitis
    A course of antibiotics might be recommended to treat the infection. In case of a nursing mother, the antibiotics would be chosen to not harm the child through breast milk. If there is an abscess, it would be located by ultrasound and then drained.  
  5. Paget disease of the breast
    In severe cases, this would be treated by a mastectomy. Although an alternative is surgically removing the nipple followed by radiation therapy.
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Prevention

Some nipple conditions are easily preventable with a few precautions such as: 

  1. Maintaining good breast hygiene while breastfeeding.  
  2. Avoid wearing fabrics that can cause friction. Adopt softer fabrics such as cotton if you are prone to friction rashes 
  3. Use products that can prevent chaffing (like talcum powder) 
  4. On medical consultation, change any medication that might be causing complications such as nipple discharge.

FAQs

1. Is nipple discharge a sign of breast cancer?

If nipple discharge is the only symptom, it doesn’t usually mean breast cancer. However, it is advisable to seek medical attention at the earliest to treat any underlying condition that is causing nipple discharge.

2. Is nipple discharge a sign of hormonal imbalance?

Nipple discharge may be caused by hormonal imbalance, thyroid disease, pituitary gland tumour, cyst or infection. It can also be a reaction to medications such as birth control pills. It is best to consult a medical practitioner to rule out any severe underlying cause.  

3. Why are my nipples itchy and bleeding?

Itchy/scaly/cracking nipples can be a sign of friction injuries due to overexertion or improper clothing. In the case of older menopausal women, it can also be Paget’s disease of the breast. Seek medical attention to get the right treatment at the right time. 

4. When should I be concerned about nipple discharge?

In many cases, nipple discharge does not indicate a more severe problem. However, if you are not nursing, it is best to consult a doctor right away to rule out (and treat if needed) breast cancer.

 
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