Nipple discharge in breastfeeding and non-breastfeeding patients

Updated December 1, 2023

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By Professor Dr See Mee Hoong
Consultant Oncoplastic Breast Surgeon,
UM Specialist Centre

There are two categories of patients experiencing nipple discharge: breastfeeding individuals, typically aged between 20 and 40 years, and non-breastfeeding patients. The latter, whether single or married, who exhibit nipple discharge outside the lactating period, warrant careful attention.

Varieties of discharge
Various types of nipple discharge exist—clear, milky, and those tinged with blood. The color, frequency, and spontaneous nature of the discharge play a crucial role in discerning potential concerns. Spontaneous and heavily blood-stained discharge signal a warning sign for potential malignancy, whereas discharge upon squeezing often indicates a benign condition.

Understanding the cause of nipple discharge
The presence of discharge stems from lesions, diseases, or papillomas within the breast lobules connected to the nipple. Benign cases may exhibit clear fluid mixed with blood upon injury or squeezing, while spontaneous discharge accompanied by blood necessitates heightened vigilance, potentially indicating early signs of cancer.

Three-step examination process
Patients reporting nipple discharge undergo a meticulous three-step examination. This involves a detailed inquiry into the discharge, confirming its source and color. Subsequently, imaging tests such as mammograms or ultrasounds are employed to assess the affected area and any additional lesions. Biopsy, if warranted, confirms the nature of suspicious lesions.

Benign and malignant presentations
The majority (80-90%) of lumps presented at the clinic are benign. The characteristics of the discharge play a pivotal role in determining urgency for investigation. However, for individuals in the 40-70 age group, the possibility of cancer is considered foremost until ruled out, especially when symptoms manifest.