Nipple discharge/nipple changes

Nipple discharge is common and rarely associated with breast cancer.

Physiological discharge is most common. Beign duct papillomas and duct ectasia are the commonest causes of "pathological" nipple discharge.

Breast cancer and DCIS do occasionally cause single duct, blood-stained discharge. Around 95% of such cases are innocent

Assessment

Distinguish eczematous skin change of the areola and breast from similar changes to the nipple itself.

Distinguish weeping from broken skin from nipple discharge

If discharge is present assess if bilateral and single or multiple ducts and character of discharge - milky or serous/bloodstained.

Discharge can be testeed for presence of blood with urine dipstick
Galatorrhoea - profuse milky discharge
- Check Prolactin level
- Check drug history for causes
- Refer endocrine if prolactin > 1000iu

Assess if nipple inversion is reversible.

Eczema of the areola or skin of the breast can be treated as eczema elsewhere in the body.

Note that Paget's disease of the nipple affect the nipple itself so a rash affecting the areola can be treated symptomatically.

For physiological discharge advise avoiding nipple manipulation.

Nipple discharge that is clear yellow with or without red blood staining
Unilateral nipple eczema that does not respond to 2 weeks of moderately potent steroid cream
New, unilateral and non-reversible nipple retraction

Very troublesome, persistent benign discharge. Duct excision may be considered but will result in a numb nipple and will not permit future breast feeding

Bilateral or multi duct discharge is either physiological or due to duct ectasia and does not require investigation or referral unless blood stained or very persistent and troublesome.
Slit-like or reversible nipple inversion does not require further investigation or referral. Surgical correction cannot be done on NHS.

Last reviewed: 11/02/2026

Next review date: 11/02/2028

Author(s): Maria Bews-Hair.

Version: 1.0