Patient's question:
I had an abortion on 8/20, and now when I squeeze my breasts, milk leaks out. What could be the reason? Before the abortion, touching my breasts would cause mild pain, but it's gone now. Could there be a suspicion of hypothalamic dysfunction, pituitary tumor, prolactinoma, or primary hypothyroidism, chronic kidney failure, or other diseases? Thank you.Doctor's answer:
Hello! First of all, I wish you a speedy recovery! I want to discuss the issue of "galactorrhea" with you. In non-pregnant and non-lactating women, the presence of fluid discharge when the nipple is squeezed is called nipple discharge. Nipple discharge is one of the common symptoms of breast diseases. Statistics show that 3-14% of patients visiting clinics with nipple discharge as the primary symptom have breast diseases, with a higher incidence rate than breast lumps and breast pain.1) If the nipple discharge is unilateral, it is often associated with the following breast diseases:
1. Mammary duct ectasia: Some patients with this condition may experience nipple discharge as an early symptom. The discharge is usually brown, occasionally bloody; laboratory tests reveal a large number of plasma cells and lymphocytes, but no tumor cells. This condition is more common in non-lactating women over 40 or postmenopausal women. The area of the nipple discharge may have a mass adhering to the skin, usually less than 3 cm in diameter. The ipsilateral axillary lymph nodes may be swollen, soft, and tender. If infection occurs, the mass may show signs of redness, swelling, heat, and pain.
2. Intraductal papilloma: This condition is more common in women aged 40-50. 75% of the tumors are located near the nipple. The tumor is small, pedunculated, and has villi with thin-walled blood vessels, making it prone to bleeding. Tumor cells can be found in the discharge through laboratory tests. Sometimes, when the breast is carefully palpated, a cherry-sized mass under the areola may be found, which is soft, smooth, and mobile.
3. Breast cystic hyperplasia: This condition is more common in women of reproductive age. In some cases, the nipple discharge may be yellow-green, brown, bloody, or colorless serous fluid. Laboratory tests show no tumor cells in the discharge. This condition has two characteristics:
- It is characterized by cyclical breast pain, which worsens before menstruation. Mild cases may not be noticed by the patient, while severe cases can affect work and daily life.
- Breast masses are often multiple, appearing in one or both breasts, or localized to a part of the breast or scattered throughout. The masses are nodular, of varying sizes, firm but not hard, not attached to the skin, and have unclear boundaries with surrounding tissues. The masses may shrink after menstruation.
4. Breast cancer: Some breast cancer patients may have bright red or dark red nipple discharge. Sometimes, clear watery discharge may occur, which is colorless, transparent, occasionally sticky, and leaves no trace after discharge. Tumor cells can be found in the discharge through laboratory tests. The peak ages for this condition are 45-49 and 60-64. The onset is gradual, and the patient may notice a breast mass unintentionally, usually located in the inner or outer upper quadrant, painless, and gradually enlarging. In advanced stages, skin changes resembling orange peel and satellite nodules may appear. Axillary lymph nodes may be swollen, hard, and fuse together as the disease progresses.
2) Additionally, the following points should be noted:
1. Is the discharge true or false: True discharge refers to fluid flowing from the breast ducts. False discharge is common in women with inverted nipples, where shed epidermal cells accumulate in the, causing a small, watery, bean-like leakage, often with an odor. Once the inverted nipple is pulled out and the area is kept clean, the "discharge" will disappear.
2. Is the discharge bilateral or unilateral: Bilateral discharge is usually physiological. For example, within one year of stopping breastfeeding, most women still have a small amount of milk secretion. In the second and third trimesters of pregnancy, some pregnant women may produce a small amount of thin colostrum from both breasts. A few women may experience temporary milk discharge after intense sexual climax due to highly congested breast blood vessels, breast enlargement, and nipple erection. During menopause, hormonal imbalance may cause some women to secrete a small amount of milk. All of these are physiological conditions and not pathological. However, bilateral nipple discharge can also be pathological, such as hypogonadotropic hypogonadism-prolactinoma syndrome, which is caused by a pituitary microadenoma. In addition to milk discharge, it may be accompanied by amenorrhea, headache, visual field constriction, and elevated prolactin levels in the blood. A brain CT scan can confirm the diagnosis. Another type of bilateral nipple discharge is seen in a small number of women with breast hyperplasia.
3. Is the discharge from a single or multiple openings: The nipple has 15-20 openings for breast ducts. When discharge occurs, observe from which one or more openings the fluid is leaking. Unilateral discharge is often associated with intraductal papilloma. Multiple openings may indicate physiological, pharmacological, systemic benign diseases, or breast hyperplasia.
4. Is the discharge spontaneous or induced: Spontaneous discharge is often pathological, as about 13% of breast cancer patients have a history of spontaneous discharge. Benign or physiological discharge is more commonly induced by squeezing.
5. Characteristics of the discharge: The nature of the discharge varies depending on the underlying breast disease. For example:
- Milk-like discharge: This is usually physiological, such as in the immediate aftermath of weaning or miscarriage, and is not a sign of cancer.
- Purulent discharge: This is often seen in mammary duct ectasia or plasma cell mastitis.
- Light yellow discharge: This is the most common type of discharge and is seen in almost all breast diseases, most commonly breast hyperplasia. Some cases may be due to intraductal papilloma or breast cancer. Therefore, this warrants increased vigilance.
- Bloody discharge: This can be bright red, coffee-colored, light yellow, or brown. Such discharge is a dangerous sign and should be highly. 50-75% of cases are due to intraductal papilloma, and 15% are due to breast cancer. If bloody discharge occurs postmenopause, 75% of cases are breast cancer.
- Watery discharge: This is colorless and transparent, occasionally sticky, and leaves no trace after discharge. Such discharge may be a sign of breast cancer and requires further examination.
In summary, nipple discharge is an important breast symptom, with 10-15% of cases potentially being breast cancer. If symptoms appear, it is important to seek medical attention promptly for discharge smear cytology examination. Near-infrared breast scanning has a positive diagnostic rate of 80-95% for ductal lesions in the areola. Ultrasound and mammography also have comparable accuracy. Selective ductography is a common examination method for nipple discharge and has significant value in differentiating benign and malignant conditions. It can also help doctors accurately locate the surgical excision area.
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