Liquid may discharge from one or both nipples and maybe creamy, clear, green, black, brown or bloodstained. Different types of discharge have different causes;
however, it is only very rarely that it means cancer.

Firstly we look at the skin surrounding the nipple to check that the fluid is not weeping from the skin itself. If the skin is healthy then we think about discharge from the milk ducts and try to find a cause. The milk ducts are tiny drainage tubes in the breast tissue. There are hundreds of them deep in the breasts joining together to form about 15 main ducts which then finally open onto the nipple.

Milky discharge (galactorrea) from both breasts is quite common and can occur :
* for months or up to a year after breast feeding has ceased
* with certain medicines
* when there is a disturbance in hormone levels

The doctor will check what medicines you are taking and may take a blood test to
check hormone levels.

Non-milky discharges are usually due to some problem in the main ducts. The doctor will examine the breasts and try to establish whether the discharge comes from one duct or more. In women over 35 a mammogram will be arranged to check there are no other problems in the breast.

The most common causes of non milky nipple discharge are:

Duct papillomas
These are warty swellings in the duct which are fragile and bleed easily. This causes a red, brown or black discharge, usually just from one duct on the nipple.

Duct ectasia
This condition usually occurs in older women. The ducts are dilated and there is a build up of fluid within it. This usually comes out of more than one duct in varying amounts. It may be yellow, clear, green or look like blood. It may happen in both breasts.

Periductal mastitis
This condition usually affects younger women and smoking is thought to be a contributing factor. There is inflammation around the breast ducts and a yellow or green discharge may indicate an infection. Breast abscesses can occur with this condition.

Treatment

* When any serious cause has been ruled out, and the discharge is only slight, treatment is not usually necessary.

* Any infection will be treated with a course of antibiotics.

* If the discharge is bothersome or causing alarm then an operation to remove the ducts running up into the nipple may be recommended.

After this type of operation there may be changes in nipple sensation and breast feeding is not usually possible from the affected side.

If you require further advice or information please contact the
Macmillan Breast Care Nurses, Hazel Ricard and Hilary Rickwood on 020 8565 5885