Patient's question:
What are those small white things on the nipples?Doctor's answer:
Generally speaking, if bilateral nipple discharge is present, it may be due to physiological or systemic conditions, such as newborns having higher estrogen levels from maternal blood, leading to a small amount of milk secretion in the first 1–2 weeks after birth; or in adults, conditions like hypothalamic-pituitary disorders causing galactorrhea-amenorrhea syndrome. If unilateral nipple discharge is present, it is more likely to be pathological and often localized, such as benign breast duct lesions or breast cancer.If multiple discharge is present, it can be physiological or due to larger pathological lesions, such as breast duct ectasia syndrome or fibrocystic breast disease. If single discharge is present, it may indicate a lesion in a specific duct, such as intraductal papilloma or intraductal papillary carcinoma.
If the discharge is spontaneous, it usually indicates a significant accumulation of fluid in the ducts, with continuous secretion, and a higher likelihood of larger pathological discharge. If the discharge is, it suggests less fluid accumulation in the ducts, and squeezing a particular area often indicates that the area may be the site of the lesion. Careful observation and identification of the characteristics of nipple discharge are highly significant for determining its cause.
Generally, milk-like discharge often appears as bilateral, multiple, spontaneous discharge during non-lactating periods, with a color and consistency similar to skim milk. It is usually caused by hypothalamic dysfunction and abnormally elevated prolactin levels in the blood. Serous discharge is often, but occasionally may be spontaneous, frequently staining clothing and can be unilateral or bilateral. The discharge is thin, transparent, light yellow or brownish, or viscous, and is mostly caused by benign breast diseases, such as fibrocystic breast disease, breast duct ectasia syndrome, or intraductal papilloma. However, some serous discharge can also be caused by breast cancer.
Watery discharge is often unilateral and appears thin and colorless, like water. It is commonly caused by tumors, with some studies indicating that about 50% of watery discharges may be malignant. Purulent discharge is often unilateral and can be spontaneous or, appearing green or creamy yellow, viscous, purulent, and may contain blood. It is more common in inflammatory breast diseases, such as breast duct ectasia syndrome. Hemorrhagic discharge is often unilateral and can be spontaneous or, appearing bright red, light red, light brown, or coffee-colored. It is mostly caused by intraductal papilloma but can also be seen in breast cancer, fibrocystic breast disease, or breast duct ectasia syndrome.
Since malignant lesions are more likely to cause hemorrhagic discharge, clinical attention should be heightened for patients with such discharge to rule out malignancy. Additionally, it is important to distinguish between true and false nipple discharge. True discharge refers to fluid expelled from the breast duct through the nipple opening, while false discharge usually refers to inflammatory exudate in the nipple area caused by superficial nipple erosion or secondary infection from breast duct fistulas. The nipple discharge discussed here generally refers to true nipple discharge.
In summary, if nipple discharge occurs, regardless of the method or characteristics of the discharge, it should be taken seriously, as most non-lactating nipple discharge is a manifestation of various breast diseases. It should be particularly noted that if male patients experience nipple discharge, the likelihood of breast malignancy is high, and it should not be taken lightly.